A case report on an unusual elongation of the Sustentaculum tali

The sustentaculum tali, as a horizontal shelf of the calcaneus serves as an attachment point for the ligamentous support of the foot. Any variations  on it has therefore been linked to instability factors of the ankle joint. Studies have explored on the possible variations of this bony projection, but  none have been documented on an unusually long elongation of the same. This study examined an unusually elongated sustentaculum tali found located on the left calcaneus of an adult Kenyan calcaneus. The right pair did not bear the same variation. This elongation on the calcaneus revealed that it had a length of 11.68mm, height of 7.68mm and thickness of 2.83mm. This elongated sustentaculum tali, even though a rare case should be considered in the cases of idiopathic subtalar joint instability. Keywords: Sustentaculum tali, calcaneu

Anomalous origin of the ulnar nerve from the lateral cord of the brachial plexus: A case report

Background:  The ulnar nerve has been noted to bear variations as concerns its origin such as that of its communication with the median nerve via nerve branches and sharing of common sheath with the medial cutaneous nerve of the forearm. However, only a few studies have reported on the ulnar nerve receiving a communicating branch from the lateral cord. Case:  We report a case in which the ulnar nerve was noted to originate from branches of the lateral cord of the brachial plexus, during routine dissection. Discussion and conclusion:  This study adds data on such a rare scenario in a Kenyan setting.   French title: Origine anormale du nerf ulnaire du cordon lateral du plexus brachial : A propos d’un cas. Introduction: Des variations de l’origine du nerf ulnaire telles que celle de sa communication avec le nerf médian via des branches nerveuses et le partage de la gaine commune avec le nerf cutané médial de l'avant-bras ont été décrites. Cependant, seules quelques études ont rapporté que le nerf ulnaire recevait une branche communicante du faisceau latéral. Observation: Nous rapportons une observation dans laquelle le nerf ulnaire provenait des branches du cordon latéral du plexus brachial, lors d’une dissection de routine. Discussion et conclusion: Cette étude ajoute des données sur un scénario rare dans un contexte kenyan

Unusually low arcuate artery in a Kenyan cadaver

The arcuate artery is one of the two major branches of the dorsalis pedis artery that supply the dorsum of the foot including interdigital spaces. The artery’s origin varies but in almost all cases it branches in the proximal third of the dorsum of the foot. During routine dissection of the right foot in a black Kenyan, we encountered a case where the artery was located and branched in the distal third of the dorsum of the foot, at the level of the metatarsophalangeal joint. This is much more distal than previously reported in prevailing literature. This artery did not give off any dorsal metatarsal arteries but gave the digital arteries directly. The dorsalis pedis artery, lateral and medial tarsal arteries had normal course in this foot.Keywords: Translational research; Dorsalis pedis artery; Integration; Arcuate arter

Dorsal Morphology of the Calcaneus—An Osteological Study

Background: The calcaneus exhibits variations in articular facets and calcaneal sulcus width. These variations influence occurrence of osteoarthritic conditions, whose prevalence is significant in our setting, and are essential during surgeries involving the foot. Despite this, local data on calcaneal facets remain scarce. Methods: Sixty calcanei were obtained from the National Museum of Kenya. The number, type and shapes of their facets were documented and calcaneal sulcus width measured. Images were taken and collected data were represented in tables and figures. Results: The calcanei had 1–3 articular facets. The common calcanei type noted was type 1B on the right calcaneus and 1B on the left. The least was type 4 on the right and 2C on the left. In terms of shape, types 1 and 4 calcanei had non-rounded facets while type 2 had rounded facets. The width of the sulcus calcanei was narrowest among type 1 calcanei in the right foot at 0.53 cm. On the left foot, type 2 calcanei had narrower (0.455 cm, range 0.35–0.60) calcaneal sulcus width. Conclusion: Our findings may aid in surgeries of the foot and in providing a link between local calcaneal variations and prevalence of osteoarthritic foot conditions. Keywords: Calcaneal-facets, Sinus tarsi, Arthriti

Conventional and variant origin of the transverse cervical artery in a select kenyan population

Data from previous studies have highlighted on the use of transverse cervical artery (TCA) flaps as posterior neck musculocutaneous flaps in  reconstructive surgeries. General preference of flap selection relies heavily on the neurovascular supply of the flap in question and even though known, the transverse cervical artery has been shown to vary among populations, therefore affecting its use as a potential flap. Additionally, variant points of origin of the trans-cervical artery have been shown to predispose to brachial plexus compression. Our data on the same, however, remains partly elucidated and therefore a study aimed at describing the conventional and variant origin of the TCA in a Kenyan population would aid in deciding on its use as musculocutaneous flaps and determining the possible prevalence of brachial plexus compression because of its variant origin. The origin of the transverse cervical artery was studied bilaterally in 26 adult Kenyan cadavers in the Department of Human Anatomy, University of Nairobi. As regards their origin, the different types were photographed and grouped into five: Types I to V relative to its origin. The data collected was then analysed using SPSS version 21 and findings presented as percentages. The findings were presented in a bar graph and pie chart. The TCA was present in all the 26 cadavers studied. Type I origin of the TCA was the most common (71.15%) while type V was the least (1.92%). While type I origin occurred mostly on the left limbs, the other types were more prevalent on the right side. The significant variant origin of the TCA and its resultant aberrant course should be important considerations during the planning of posterior neck musculocutaneous flaps as well as in understanding brachial plexus compression associated with its variant origin. Key Words: Anatomy, Transverse cervical artery

Perception and challenges of health science students toward e-learning in a Sub-Saharan African country: a multi-institutional study

Background: E-learning is important in improving access to quality health sciences education. This study aimed to determine the perspectives of Kenyan health science students toward e-learning in a bid to enhance effective learning during the COVID-19 pandemic and beyond. Methods: This descriptive cross-sectional study targeted 294 Kenyan health science students. Approval was obtained from the Kenyatta National Hospital–University of Nairobi Ethics Research Committee, and informed consent was obtained from participants. Data were collected using Google Forms and analyzed using SPSS version 27.0. A p value ≤0.05 was considered significant at 95% confidence interval. Results: Most students had good knowledge of online learning; 74.9% reported having received training on the same by their universities and 74.5% further reported to have taken tests on the same. Almost half (45.5%) were knowledgeable of the use of the internet to access materials. Most (79.6%) portrayed a positive attitude toward online learning, agreeing to its use as an integral part of learning. However, 70.2% noted a decrease in concentration and changes in reading habits (44.7%). Regarding challenges faced, unreliable internet connection (56.9%) and lack of motivation (73.7%) were common. Conclusion: The majority of the Kenyan health science students portrayed good knowledge, attitude, and practice toward e-learning amidst challenges

LIGHT MICROSCOPIC CHANGES IN THE VILLI HEIGHT OF THE SMALL INTESTINES OF LABORATORY RAT (RATTUS NORVEGICUS) FOLLOWING MEBENDAZOLE ADMINISTRATION; Pequeños cambios microscópicos observados en la altura del vello en el intestino delgado de la ratas de laboratorio (rattus norvegicus) después de la administración de mebendazole.

  Through tubulin degradation, mebendazole interferes with glucose uptake into intestinal cells and exhaustion of glycogen reserves leads to parasite death. When used in humans, the drug may mediate mucosal changes responsible for reported side effects including diarrhea. Earlier studies have shown changes to the goblet and crypt cells in mammalian intestines. Its effects on the intestinal villi height has not been determined. Forty laboratory rats were used; ten rats, for determination of baseline features whereas three experimental groups of five rats received 1.6ml of MBZ for three, eight, and thirty days respectively. Once sacrificed, the rats from the interventional and control groups were dissected to harvest 5mm sections from duodenum, jejunum and ileum. These were processed, sectioned and stained for light microscopy to demonstrate cryoarchitecture. The villi were measured and data represented in medians. Mann Whitney U test was done to check for differences between controls versus experimental groups at specific time points, Krus Kall Wallis test, for differences among experimental groups or control groups alone. Mebendazole administration was associated with initial reduction in the villi height. The lowest value recorded was after 3 days in the duodenum and 8 days in the jejunum/iluem, beyond which continued MBZ administration was associated with increase in villous height until day thirty. Findings of this study suggest that MBZ does not have effects on the villous height when used for prolonged periods. This explains why patients who use the drug for long-term periods tolerate it.   Mediante la degradación de la tubulina, el mebendazole (MBZ) interfiere con la entrada de glucosa a las células intestinales, y el agotamiento de las reservas de glucógeno causa la muerte de parásitos. Al ser utilizada en seres humanos, el medicamento puede fungir como intermediario de cambios en las mucosas que pueden causar efectos secundarios reportados, incluida la diarrea. Los estudios anteriores han demostrado cambios en los intestinos de mamíferos, los cuales afectan las células caliciformes y células en las criptas de Lieberkuhn. No se han determinado aún sus efectos en la altura del vello intestinal. Se utilizaron cuarenta ratas de laboratorio; diez ratas para determinar características básicas, mientras que tres grupos experimentales de cinco ratas recibieron 1.6 mL de MBZ por tres, ocho y treinta días, respectivamente. Una vez que fueron sacrificadas, las ratas de los grupos de intervención y de control fueron disecadas para obtener secciones de 5 mm de su duodeno, yeyuno e íleon. Estos segmentos fueron procesados, seccionados y entintados para microscopía de la luz, para determinar su arquitectura celular bajo congelación. Se midieron los vellos y se utilizaron las medias como datos. Se realizó la prueba de Mann-Whitney para determinar si existían diferencias entre los grupos de control y experimentales tratados por plazos específicos de tiempo, y se realizó la prueba de Kruskal-Wallis para identificar sólo las diferencias entre grupos experimentales y grupos de control. La administración de mebendazole estuvo asociada con la reducción inicial en la altura del vello. El valor registrado más bajo ocurrió después de 3 días en el duodeno, y 8 días en el yeyuno y el íleon. Después de este tiempo, la continuación de la administración de MBZ fue asociada con un aumento en la altura del vello hasta el día treinta. Los hallazgos de este estudio sugieren que el MBZ no surte efecto alguno en la altura del vello intestinal si se utiliza por plazos largos de tiempo. Esto explica por qué los pacientes que utilizan el medicamento a largo plazo llegan a tolerarlo

Anatomical Variations of The Fifth Lumbar Artery in A Sample Kenyan Population

Background: The fifth lumbar arteries have a more variable presence and origin as compared to the first four arteries. Its anatomical variations may influence lower spine surgical and vascular interventions. Aim: Our objective was to determine the variations of the fifth lumbar artery in a cadaveric and contrast computed tomography (CT) study. Materials and methods: This descriptive cross-sectional study combined data from 90 cadaveric and 120 post-contrast abdomino-pelvic computed tomography (CT) from Human Anatomy Department, University–of-Nairobi and Radiology Department, Kenyatta-National-Hospital. Cadavers were dissected to expose the arteries. Their prevalence, patterns and position of origin on the 5th vertebral bodies were determined. Data were analyzed using SPSS. Results: The artery was present in 26.7% of the cadaveric group, and 16.7% of the CT group. It was only noted in males in both the cadaveric and CT groups. It originated bilaterally as a common stem in 50% and as paired single branches in 50%. It originated at a mean distance of 9.03mm ± 7.23mm from the top of the L5 vertebra, maintaining a consistent relation to the upper third (90%) and the middle third (10%) of the body. Conclusions: The arteries were only noted in males and portrayed population specific variations