Effect of Magnesium Sulphate in Mothers suffering from Toxemia of Pregnancy and their Neonates

Background: Severe pre-eclampsia is one of the major causes of high maternal mortality rate in both developed and developing countries. The goals of management are to prevent progression to eclampsia thus preventing convulsions, to control the blood pressure and to prevent untoward effects in the foetus. The first-line option for the treatment and prevention of eclamptic seizures is magnesium sulphate. Objective: To determine the serum magnesium, urea and electrolyte levels in neonates of mothers treated with magnesium sulphate and compare the findings with the levels in non-exposed neonates. Methodology: A quasi experimental design was adopted where test subjects were neonates of mothers suffering from preeclampsia and severe eclampsia and were being treated with magnesium sulphate just before delivery at Pumwani Maternity hospital. The control group comprised neonates of hypertensive mothers without preeclampsia being treated using other drugs. Blood samples were obtained from the mother at onset of labor and from the neonates at birth and analyzed in the clinical chemistry laboratory of the University of Nairobi. Results:  A total of 54 mothers and their neonates were enrolled with 27 in each arm of the study. The mean maternal serum magnesium in the test group was significantly higher than in the control group (p = 0.008). The mean neonatal serum magnesium in the test group was also significantly higher compared to the control group (p = 0.008). There were statistically significant differences in serum sodium (p = 0.015), urea (p = 0.043) and creatinine (p = 0.008) levels between the maternal test and control groups. There were significant differences in serum urea (p = 0.007) and chloride (p = 0.017) between the neonatal test and control groups. The calcium and potassium levels were elevated in the test group but not to significant levels. There was a positive correlation between maternal and neonatal serum magnesium levels in both groups stronger in the test group (r = 0.56, p = 0.003) as compared to the control group (r = 0.35, p = 0.087). Conclusion: Maternally administered magnesium sulphate raises urea and creatinine levels to significant levels in mothers. Calcium levels are also raised while in mothers not receiving magnesium sulphate they were slightly lower. In neonates the urea and chloride levels are elevated to significant levels while the calcium and potassium levels are not significantly elevated. We suggest monitoring of both in the immediate post-partum period. Keywords: Preeclampsia, eclampsia, magnesium sulphate, neonate, serum urea and electrolytes

Factors that influence adequacy of asthma control in children residing in Naivasha, a flower growing area in Kenya

Background: In Kenya, asthma affects 10% of the population. One of the modifiable risk factors contributing to asthma morbidity and mortality is environmental exposure. Naivasha flower farms introduce pesticides persistently into the environment and these may drift onto residential property or other areas where children play. Proximity of households to the pesticide treated farms may also increase exposure of children to the pesticides. Pesticide exposure has been shown to exacerbate already existing asthma, a relationship that has not been studied in Kenya. Objectives: To identify risk factors that exacerbate asthma and influence adequacy of Asthma control in children residing in a flower growing area in Kenya. Methodology: The design was a cross-sectional study that involved 150 asthmatic children aged 5-12 years residing a flower growing area.  The study was conducted between May and July, 2014 in Naivasha, which is home to Kenya’s largest horticultural flower farms.  Participants were interviewed using a structured questionnaire while asthma control was measured using a validated Asthma control tool. Logistic regression was done to identify variables that affected asthma control. Results: Majority of the asthmatic children were males (56.7%) while females were 43.33%. Risk factors that were found to be significantly associated with asthma control were; duration of stay in or near a flower farm (OR = 0.723, 95%CI (0.538-0.975), presence of a smoker in the family (OR = 0.463, 95%CI (0.094-22.629) and presence of household pet (OR = 4.358, 95%CI (1.182-16.057). There was no significant relationship between the child’s asthma control and age of child, sex of child, distance of school from flower, guardian’s level of education, guardian’s income, and guardian’s occupation as a flower farm worker, child’s age of diagnosis and use of indoor pesticides. Conclusion:  The use of Integrated Pest Management (IPM) should be promoted as it keeps environmental exposure pesticides to a minimum. Key words: asthma, household pet, flower farm, pesticide, smokin

Effect of Pesticide Exposure on Serum Cholinesterase Levels among Asthmatic Children in Naivasha Sub-County, Kenya

Background: Pesticide exposure is a risk factor for asthma exacerbations in flower farm regions in the world.  Data on levels of serum cholinesterase among asthmatic children exposed to pesticides in Kenya is scanty. Objectives: To compare and identify variables which affect the concentration of serum cholinesterases in children who are exposed and unexposed to pesticides. Methodology: The design was a comparative cross-sectional study that involved exposed and unexposed children.  The study was conducted between May and July, 2014 in Naivasha, Kenya.  Patients were interviewed and serum samples were analysed for cholinesterase levels.  Multi-linear regression was done to identify variables that affected cholinesterase activity. Results: Children who were exposed to pesticides had a lower median ChE activity of 5828 [IQR 4863, 6443] compared to the unexposed arm whose median was 7133 [IQR 6063, 8179].  Five predictor variables were found to be significantly associated with depression of serum cholinesterase levels.  The most important predictor variable for the levels of ChE in children, was not using protective clothing by the parent [adjusted β -1457.0 (95% CI - 2594, 1319.8)].  Others were not using household pesticides [adjusted β 96.3, (95% CI 22.6, 170.0)], female sex [adjusted β -695.7 (95% CI -1296.2, - 95.3)], non school attendance [adjusted β -1676.8 (95% CI -3371.6, 18.1)] and not taking a break after spraying [adjusted β 1105.5 (95% CI (315.0, 1895.2)]. Conclusion: Children who were exposed to pesticides had low cholinesterase levels. Parents should therefore be encouraged to wear protective gear as this conferred protection of children from the effects of pesticide exposure. Key words: asthma, exposure, children, pesticides, cholinesterase

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence