Imaging patterns of liver diseases diagnosed by ultrasound guided liver biopsies at Moi Teaching and Referral Hospital

Background: Liver biopsy is useful in making diagnosis, assessing the prognosis of liver diseases and in making decisions for therapeutic management. Interventional radiology is a rapidly growing subspecialty, with very few personnel, more so in developing countries.Objective: To describe the imaging patterns of liver diseases diagnosed by ultrasound guided liver biopsies at Moi Teaching and Referral Hospital. Design: Cross sectional study Setting: Moi Teaching and Referral Hospital (MTRH), Radiology and Imaging Department and Histopathology laboratory over one-year period from July 1st 2013 to June 30th 2014 Subjects: All consenting patients referred for ultrasound guided liver biopsy were studied with a sample size of 36 patients. Results: Hepatocellular carcinoma (HCC) was the commonest pathology that was diagnosed (n=21). Most HCC lesions were larger than 5cm (n=18, 90%) and 85% of these lesions were heterogeneous on ultrasonography. Conclusions: Hepatocellular carcinoma larger than 5cm and heterogenous in pattern is the commonest liver lesion diagnosed in Moi Teaching & Referral Hospital. A larger study is recommende

Commodification and End of Ethics in International Relations

This paper interrogates the practice of commodification and ethics in international relations. Compounding the dilemma of practice of ethics among states is the rise of commodification due to liberalism in a globalizing world where competition is about commercialization trends. Using an analytical qualitative and speculative approach, this paper sets to; probe whether commodification is likely to sweep away ethics in International Relations (IR), find out the practice of ethics in economic play among states, and finally highlights likely effects of commodification to ethics. The conclusion that relaxation of rules in IR due to commodification against ethics is arrived at. Key Words: Commodification/ International Relations/ Ethics/ States/ International Ethics/ Extra- Territorial/ Bilateral/ Multi- Lateral/ International System/ Economic system

Adherence to self-administered tuberculosis treatment in a high HIV-prevalence setting: a cross-sectional survey in Homa Bay, Kenya.

Good adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools

Performance of the 2007 WHO Algorithm to diagnose Smear-negative Pulmonary Tuberculosis in a HIV prevalent setting

The 2007 WHO algorithm for diagnosis of smear-negative pulmonary tuberculosis (PTB) including Mycobacterium tuberculosis (MTB) culture was evaluated in a HIV prevalent area of Kenya

Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

<p>Abstract</p> <p>Background</p> <p>The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.</p> <p>Methods</p> <p>The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.</p> <p>Results</p> <p>A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.</p> <p>Conclusions</p> <p>The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.</p

Applying Artificial Intelligence and Mobile Technologies to Enable Practical Screening for Diabetic Retinopathy

With burgeoning middle class populations and changing lifestyles, diabetes is rapidly emerging as a major health concern worldwide. A related complication, Diabetic Retinopathy (DR), affects approximately 1 of 3 people with diabetes and is the leading cause of adult blindness worldwide. Since DR often goes undiagnosed, there has been great interest in using artificial intelligence in the form of Deep Learning algorithms to automatically predict DR using retina (fundus) images. However, the practical application of these algorithms is impeded by the different levels of DR severity, limited algorithm reproducibility, and a large variability in fundus imaging devices. To address these concerns, I present the development of an image processing pipeline and a neural net algorithm that automatically tests image quality (based on brightness, color, and amount of blur), rejects poor quality images, and re-formats each image into a standard image resolution. In order to create a generalized model, I used a public Kaggle database or approximately 35,000 retina images and applied a transfer learning approach using the Inception v3 architecture, to build a convolutional neural net (CNN) model that predicts referable DR. As expected, the performance of the resulting model depended on the severity of DR, with AUCs ranging from 0.96 for severe DR to 0.74 for mild DR. I further customize the model using a smaller data set of 1156 smart-phone images from our clinical partner in India. On the Kaggle dataset, the best model achieved a sensitivity = 0.85 and specificity = 0.87. On the smaller dataset, the model attained a sensitivity = 0.82 and specificity = 0.80. Finally, as a possible alternative to fundus imaging, I explore the use of iris images to explore possible correlations with diabetic retinopathy and diabetes. Using cluster analysis and generating plots with PCA and T-SNE, we observed possible clusters in using GLCM features; however, there was insufficient data from healthy individuals to be able to draw any significant conclusions.M.Eng

Knowledge, attitudes and practices of private medical practitioners on tuberculosis among HIV/AIDS patients in Eldoret, Kenya

Background:Tuberculosis (TB) is one of the major communicable diseases afflicting mankind today. Its prevalence is increasing with increase in HIV infection. It is important that doctors be able to correctly diagnose and institute proper management of patients with TB. Objectives: To determine the knowledge, attitudes, and practices (KAP) of private medical practitioners in Eldoret on the management of TB. Design: Cross-sectional descriptive qualitative study. Setting:Private medical practitioners' clinics and the outpatient departments of private hospitals in Eldoret town, western, Kenya. Eldoret is a cosmopolitan town 350-km north west of Nairobi. It is the main town in the north Rift Valley with such infrastructure as roads, international airport, and banks. Subjects: Private medical practitioners in Eldoret. Results:Fifty three out of 70 private doctors were interviewed. Of these 84.9% were male. Only 5.7% knew that sputum for AAFBs is collected on spot, early morning, and spot, whereas 69.8% and 13.2% said it should be collected on three and six consecutive early mornings respectively. Sputum and chest X-ray were the most common investigations used to diagnose TB. Few doctors knew that the clinical features considered as suspicious for TB in children were failure to thrive (FTT) (20.6%), contact with open TB case (12.8%), and cough for more than two or more weeks (7.8%). Others wrongly considered cough for four or more weeks (9.2%). Features correctly considered of diagnostic value by a few of the private doctors in paediatric TB were: chest Xray (19.8%), FTT (8.7%), positive sputum for AAFBs (8.7%), and history of contact with TB case (8.7%). A small number of doctors based their diagnosis on chest Xray (38%), AAFBs (19%), and Keith-Jones criteria (6.3%). There were 16 regimes mentioned and used for the treatment of TB. The NLTP recommended regimes such as 2RHZ/4RH, 2RHZE/6HE, 2RHZ/6HE and 2SHRZE/1RHZE/5HRE, were used by 9(19.6%), 2(4.3%), 0% and 0% of the doctors respectively. The rest used unrecommended regimes and no doctor used the re-treatment regime of 2SHRZE/1 RHZE/5RHE. Similar regimes were used for the HIV as for the non-HIV-infected patients. None of the interviewees had appropriate knowledge on all the areas of diagnosis, treatment, case recording, and follow up. Conclusion:Most doctors were not aware of the correct diagnosis and treatment of TB and many used unrecommended treatment regimes. They were generally unfamiliar with the recording system of TB cases. Most doctors did not know the definitions of the various re-treatment cases. Continuing medical education on clinical management of TB patients is needed for doctors in private practice. (East African Medical Journal: 2003 80(2): 83-90

KNOWLEDGE, ATTITUDES, AND PRACTICES OF PRIVATE MEDICAL PRACTITIONERS ON TUBERCULOSIS AMONG HIV/AIDS PATIENTS IN ELDORET, KENYA

ABSTRACTBackground: Tuberculosis (TB) is one of the major communicable diseases afflictingmankind today. Its prevalence is increasing with increase in HIV infection. It isimportant that doctors be able to correctly diagnose and institute proper managementof patients with TB.Objectives: To determine the knowledge, attitudes, and practices (KAP) of privatemedical practitioners in Eldoret on the management of TB.Design: Cross-sectional descriptive qualitative study.Setting: Private medical practitioners’ clinics and the outpatient departments of privatehospitals in Eldoret town, western, Kenya. Eldoret is a cosmopolitan town 350-km northwest of Nairobi. It is the main town in the north Rift Valley with such infrastructureas roads, international airport, and banks.Subjects: Private medical practitioners in Eldoret.Results: Fifty three out of 70 private doctors were interviewed. Of these 84.9% weremale. Only 5.7% knew that sputum for AAFBs is collected on spot, early morning,and spot, whereas 69.8% and 13.2% said it should be collected on three and sixconsecutive early mornings respectively. Sputum and chest X-ray were the most commoninvestigations used to diagnose TB. Few doctors knew that the clinical featuresconsidered as suspicious for TB in children were failure to thrive (FTT) (20.6%), contactwith open TB case (12.8%), and cough for more than two or more weeks (7.8%). Otherswrongly considered cough for four or more weeks (9.2%). Features correctly consideredof diagnostic value by a few of the private doctors in paediatric TB were: chest Xray(19.8%), FTT (8.7%), positive sputum for AAFBs (8.7%), and history of contactwith TB case (8.7%). A small number of doctors based their diagnosis on chest Xray(38%), AAFBs (19%), and Keith-Jones criteria (6.3%). There were 16 regimesmentioned and used for the treatment of TB. The NLTP recommended regimes suchas 2RHZ/4RH, 2RHZE/6HE, 2RHZ/6HE and 2SHRZE/1RHZE/5HRE, were used by9(19.6%), 2(4.3%), 0% and 0% of the doctors respectively. The rest used unrecommendedregimes and no doctor used the re-treatment regime of 2SHRZE/1 RHZE/5RHE. Similarregimes were used for the HIV as for the non-HIV-infected patients. None of theinterviewees had appropriate knowledge on all the areas of diagnosis, treatment, caserecording, and follow up.Conclusion: Most doctors were not aware of the correct diagnosis and treatment ofTB and many used unrecommended treatment regimes. They were generally unfamiliarwith the recording system of TB cases. Most doctors did not know the definitions ofthe various re-treatment cases. Continuing medical education on clinical managementof TB patients is needed for doctors in private practice

On the Use of Regression Models to Predict Tea Crop Yield Responses to Climate Change: A Case of Nandi East, Sub-County of Nandi County, Kenya

Tea is a major cash crop in Kenya. Predicting the potential effects of climate change on tea crops prompts the use of statistical models to measure how the crop responds to climate variables. The statistical model was trained on historical tea yields, and how they related to past data on maximum temperature, minimum temperature and precipitation over Nandi East Sub-County. Scatter diagrams for selected months were generated from tea yield and temperature data. A multiple linear model was developed to predict tea yield using climatic variables. A contingency table was used to verify the model. Results from an analysis of trends in rainfall depicted a positive trend and revealed an increased frequency of annual droughts. The study showed that the frequency of extreme rainfall events during September-October-November (SON) season has decreased. Results from an analysis of the trends in temperature revealed that the minimum temperatures are increasing and that the frequency of extreme events has increased. Rising maximum temperatures were observed in March. The study revealed that May, the cold month, is becoming warmer. Correlation analysis indicated that the climatic variables during some months in both the concurrent year and the previous year were positively correlated with the tea yield. However, there was an inverse relationship between maximum temperature and rainfall. Results of model verification revealed that that 70% of model forecasts were correct. The results also showed that at least half of the observed events were correctly forecasted and thus the majority of the forecasts were true. An equation for predicting the yield of tea from the climate variables is presented