Current global status of female genital mutilation: A review

Objective: To provide an overview of the current global status of female genital mutilation (FGM) or female circumcision practised in various countries.Data source: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier werealso reviewed including the various techniques and tools used, the “surgeons or perpetrators” of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation hasresulted in little or no success were also critically reviewed.Conclusion: FGM remains prevalent in many countries including African countries where over 136 million women have been ‘circumcised’ despite persistent and consistent efforts byvarious governments, WHO and other bodies to eradicate the ritual by the year 2000 AD. This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation andadequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than throughFGM

Sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi

Objective: To evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi.Design: Prospective open label extension study.Setting: Urology clinics at the Nairobi Hospital, Kenyatta National Hospital and the author's private clinic in Hurlingham, Nairobi.Participants: Two hundred and nineteen adult male patients with erectile dysfunction.Results: The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. One hundred and nineteen patients (54.34%) had organic causes, 85patients (38.81%) had pyschogenic causes and 15 patients had mixed causes. Two hundred patients (91.32%) had improved sexual function after treatment with viagra. This improvement was sustained during the study period of sixteen weeks and included improved erectile andorgasmic functions and overall sexual satisfaction. One hundred and fifty seven of these patients responded to therapy with 50mg of viagra; 40 patients with 25mg and three patients with 100mg of therapy. Nineteen patients (8.68%) had no improvement in sexual functionafter viagra administration. Seven patients (3.2%) had adverse effects which were mild and transient. They included mild headaches in three patients, mild dyspepsia in two patients and facial flushing and nausea and vomiting in one patient, respectively.Conclusion: Oral sildenafil (Viagra) is an effective well tolerated and simple treatment for male erectile dysfunction in the majority of cases. The cost of treatment at about ten United States dollars for the 50mg tablet is prohibitive and may limit its wide use by many deserving patients in this locality

Management and survival in advances prostate cancer in Nairobi

Objective: To evaluate the management and survival of patients with advanced prostate cancer in this locality.Design: A prospective case study.Setting: Kenyatta National Referral Hospital and the Nairobi and Mater Hospitals.Patients: Fifty nine patients with advanced cancer of prostate (extra prostatic locally advanced and metastatic cancer).Results: Transperineal trucut needle biopsies of the prostate revealed 15 patients (25.42%) had poorly differentiated cancers with Gleasons scores greater than 7. Fifteen patients (25.42%) had moderately differentiated cancers with Gleason scores of 6; and twenty nineother patients (49.2%) had well differentiated cancers with Gleason scores of 4 and below. Surgical castration was effected on 15 patients four of whom also had 50 mg of oral bicalutamide (casodex) daily. Thirty six patients were treated with subcutaneous goserelin (zoladex) depot 3.6mg every 28 days. Ten of these patients also had 50 mg oral casodex daily in addition to the zoladex. Three patients in this group also had external radiotherapy for severe bone pains. Only eight patients were treated with oral diethylstilboestrol 3 mg daily.All the 15 patients with undifferentiated cancers died within 12 months. Of the 22 patients surviving at 48 months irrespective of the method of treatment, 20 of them had well differentiated cancers with Gleasons scores of 4 or less.Conclusion: Survival in the undifferentiated and poorly differentiated prostrate cancer Gleasons grades 4 and 5 with a score of over 7 is poor irrespective of the mode of treatment as all the patients in this group were dead within 12 months of diagnosis. Twenty patients (90.90%) of the surviving patients at 48 months had well differentiated cancers Gleasons grades 1 and 2 with scores of 4 or less indicating better prognosis for these tumours which are known to be slow growing with a much longer tumour doubling time

Brain abscess: a review

Objective: To carry out a current review of brain abscess data source: review of all the published literature on the brain abscess until august 2016 was carried out through internet, google, pubmed and medline searches.Data selection: Published data on brain abscess were included in the review.Data extraction: Abstracts of relevant articles identified were assessed, read and analyzed to determine their relevance to the brain abscess, the subject under review.Data synthesis: After establishing relevance from the abstract, the entire paper was read and the significant points included in the subject under review.Conclusion: Brain abscesses are rare with significant consequences of missed or delayed diagnosis, but remain one of the most common neurological emergencies especially in developing countries, being 8% of intra-cranial space occupying lesions compared to 1%-2% in the developed countries. In the pre-antibiotics, CT, and MRI eras, brain abscess was almost always 100% fatal. The reduction in morbidity and mortality over the past five decades is attributed to recent advances and increased availability of computer tomography with double contrast enhancement which provides early and reliable diagnosis, localisation, and characterisation of abscesses and monitoring the effectiveness of treatment. Magnetic resonance imaging (MRI) with gadolinium enhancement has much greater sensitivity and specificity than CT making it the procedure of choice, while MRI together with diffusion weighted imaging with a sensitivity and specificity of 90% distinguishes brain abscesses from necrotic brain tumours. Advances in microbiological isolation techniques, efficient combination anti-microbial, anti-tuberculus and anti-fungal therapy, stereotactic aspiration and technology assisted neurosurgical techniques have resulted in significant reduction in morbidity and mortality globally

Cancer of the penis at Kenyatta National Hospital

Objectives: To determine how common cancer of penis is in this locality compared to all other malignant tumours and urological malignancies, and to determine and comment on the various methods of treatment available at KNH.Design: A retrospective case study.Setting: Kenyatta National Referral Hospital, Nairobi.Subjects: All patients with histologically confirmed cancer of penis at the Kenyatta National hospital between January 1970 and December 1999.Results: There were 55 patients with penile cancer representing 0.1% of all malignancies during the study period. The mean age was 47.9 years with a peak incidence between 40-61 year age groups. Penile cancer was the most rare urological tumour representing 5.1%. Themost common was prostate cancer (56.0%), followed by bladder cancer (25.0%), kidney cancer (7.9%), and testicular cancer (6.1%). Thirty eight patients (69.1%) presented with advanced disease, Jacksons stages III and IV. The majority (96.4%) of the patients hadglandular and preputial involvement. Histologically, 56.4% had well differentiated squamous cell carcinoma, (23.6%) had moderately differentiated and (20.0%) had undifferentiated carcinoma. Forty patients (72.7%) were circumcised, nine patients (16.4%) were circumcised as adolescents and three patients (5.5%) circumcised as adults. Twenty five patients had partial penectomy with radiotherapy and or chemotherapy. Eight patients had total penectomy and radiotherapy while four patients had local excision and radiotherapy. Eleven other patients had radiotherapy either alone or combined with chemotherapy. Two patients had circumcision only and inguinal lymphadenectomy was effected on five patients after penectomy and radiotherapy.Conclusion: Penile cancer is rare and the least common urological malignancy in this locality. It occurs in younger men with a mean age of 47.9 years, and presents as advanced Jackson's stages III and IV disease. The majority of patients had penectomy and local excision followed by radiotherapy

Testicular cancer at Kenyatta National Hospital, Nairobi

Objective: To determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital. Design: Retrospective case study of testicular cancer patients over a fifteen year period.Setting: Kenyatta National Hospital, a referral and teaching hospital.Participants: All histologically confirmed testicular cancer patients recorded at theHistopathology Department of Kenyatta National Hospital between 1983 and 1997.Results: The mean age was 34.8 years with a peak incidence in the 30-44 year age group. History of cryptochirdism was obtained in 10.26% of the patients. Thirty one patients (79.49%) presented with painless testicular swellings, eleven (28.08%) with pain, nine(23.08%) with scrotal heaviness, six (15.38%) with abdominal swellings and one (2.56%) each with gynaecomastia and eye swelling. On examination 32 patients (82.05%) had testicular masses, ten (25.64%) had abdominal masses, seven (17.91%) had supraclavicularand cervical lymphadenopathy, and one each (2.56%) had gynaecomastia and eye mass respectively. More than eighty nine per cent had germ cell cancers with seminoma accounting for 67.35%, teratoma 12.24%, embroyonal carcinoma 8.16%, rhabdomyosarcoma 6.12% and malignant germ cell tumour, orchioblastoma and dysgerminoma each accounted for 2.04%. Three patients (7.7%) had orchidectomy and radiotherapy and chemotherapy, sixteen (41.03%) had orchidectomy and radiotherapy, six (15.38%) had orchidectomy and chemotherapy, ten (25.64%) had radiotherapy and chemotherapy, three (7.7%) and two (5.13%) had only chemotherapy and radiotherapy respectively. No cisplastin based chemotherapy regime was used. Follow up was effected for eighteen patients (46.15%) and seven patients (38.89%) were alive after five years.Conclusion: Prognosis with current regimes was poor with survival of only 38.89% after five years. Cisplastin based chemotherapy with up to 90% cure rates should be included as a component of testicular cancer management at Kenyatta National Hospital

Fournier’s gangrene in the HIV era

Background: Fournier’s gangrene is a devastating condition that affects mostly patients whose immunity has been reduced. There is increasing evidence for increasing incidence of the disease in those with HIV disease.Objective: To evaluate the presentation, bacteriology and outcome of Fournier’s gangrene in our area in recent times in view of the high prevalence in Nairobi and its environs.Results: One hundred and forty six patients were treated for Fournier’s gangrene during the study period; all were male. They had a mean age of 38.6 years (range 2 months – 86 years). HIV infection was the most common associated underlying illness (16.4 %), followed by diabetes mellitus and alcoholism (11%).Conclusions: HIV infection is emerging as leading predisposing factor and has overtaken diabetes in predisposing for Fournier’s gangrene in Kenyatta National Hospital.Keywords: Fournier’s gangrene, HIV

Urolithiasis in Nairobi, Kenya

Background: Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practicedObjective: To review the presentation and management of patients presenting with urolithiasis in Nairobi, KenyaDesign: A retrospective study Setting: The Nairobi hospital and Upper Hill Medical Centre a day care facility next to the Nairobi hospitalSubjects: One hundred and twenty five males and fifty three females aged 9 to 75 yearsResults: One hundred and seventy eight patients were treated for urolithiasis over a five-and- half year period. Their mean age was 44.8 years, and the median was 45 years The 178 patients required 262 procedures to achieve stone clearance. One hundred and two patients had ESWL, with an overall stone clearance rate of 95%. Twentythreepatients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopicManagement: Fourty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval.Conclusions: This study demonstrates a higher annual incidence of urolithiasis in Nairobi than earlier literature. Study demonstrates that ESWL and ureteroscopic methods are highly effective in the treatment of renal and ureteral calculi as day care procedures

Psychiatric manifestations of brain tumours: a review

Objective: To carry out a current review of psychiatric manifestations of brain tumoursData Source: To carry out a review of psychiatric manifestations of brain tumours utilizing electronic databases in the internet including Google Scholar, PubMed, Medline, MedScape and Psych Info Searches.Data Extraction: Abstracts of relevant articles identified were assessed, read, and analysed to determine their eligibility and relevance to the subject under reviewData Synthesis: After establishing eligibility and relevance from abstracts, the entire article was read and the significant points incorporated in the subject under reviewConclusion: Tumours of the brain can present clinically with neurological or psychiatric symptoms or a combination of both. Rarely patients present with psychiatric symptoms without physical or neurological localizing symptoms frequently leading to misdiagnosis and mistreatment with psychotropic drugs. Clinicians must have high index of suspicion when managing psychiatric symptoms that are atypical, new-onset, anxiety, or with poor response and resistance to known and efficacious psychopharmaco-therapy treatment regimes, as there may be an underlying brain tumour responsible for the symptomatology. This must be ruled out through effective neuro-imaging techniques including Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI), and if diagnosis confirmed, treated definitively by surgical excision, radiotherapy and chemotherapy alone or in combination