Liver Function Markers and Associated Serum Electrolytes Changes in HIV Patients Attending Patient Support Centre of Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu County, Kenya

Objective: To determine the distribution of markers of liver function  disorders and their association with co-existing fluids and electrolytes states in ambulatory HIV infected individuals.Design: A case-control study.Setting: Jaramogi Oginga Odinga Teaching and Referral Hospital’s Patient Support Centre.Intervention: Biochemical analysis were performed for serum alanine-aminotranferase (ALT), aspartate-amino transferase (AST), total protein, albumin, glucose, urea, potassium, sodium, chloride, creatinine phosphate, total and direct bilirubin levels as well as CD4 lymphocyte levels.Results: Serum liver function markers were significantly altered in HIV infected individuals compared to uninfected individuals (mean serum aspartate-amino transferase (AST); 45.1U/l v/s 36.9U/l; alanine-aminotransferase (ALT), 36.5U/l v/s 30.7U/l; direct bilirubin, 4.9ìmol/l v/s 4.2ìmol/l; total bilirubin, 6.2ìmol/l v/s 5ìmol/l; albumin32.8g/l v/s 34.5g/l and protein 64g/l v/s 67.1g/l; p <0.0001). The prevalence of pathological levels of serum liver function markers was also higher in HIV-infectedpatients than HIV-negative participants (ALT, 4.4% v/s 0.7%, p=0.001; AST, 24.5% v/s 6.7%, p<0.0001; direct bilirubin, 43.1% v/s 36.5%, p=0.026; total bilirubin, 2.3% v/s 0%, p=0.002; serum albumin, 60.1% v/s 52.2%, p= 0.009 and serum total protein levels, 52.8% v/s 36%,  p<0.0001). Gender, age and anti-retroviral treatment were not predictors ofaberrations in levels of liver function markers in HIV infected patients. Marked CD4 depletion was associated with enhanced deterioration of liver function markers. Liver function anomalies did not conduce co-existing electrolyte anomalies as clinically altered ALT states only correlated and co-varied with AST states (r = 0.917) ; direct biliribun states co-varied with total bilirubin levels (r = 0.958) and serum album states correlated with protein levels (r = 0.917) and vice versa.Conclusion: Liver function disorders are not infrequent in HIV infected  individuals and routine review of liver health status is essential in  comprehensive care of HIV patients

Kidney function predictors and associated serum electrolytes changes in HIV out patients attending Jaramogi Oginga Odinga teaching and referral hospital, Kisumu county, Kenya

Background: Kidney disease has been recognised as one of the health challenges complicating HIV infection, prognosis and management. Early recognition, diagnosis and treatment are therefore key to ameliorating the deleterious impacts of kidney disease in HIV infected patients.Objectives: To assess serum kidney function markers in order to highlight the state of kidney health and the impact of its functional impairment on other serum electrolytes and body fluids parametersDesign: A case-control study.Setting: At Jaramogi Oginga Odinga Teaching and Referral Hospital’s Patient support centre.Subjects: Eight Hundred HIV positive and 406 HIV negative participants above 18 years of age.Results: Mean serum creatinine and urea levels was significantly elevated in HIV – infected individuals than the healthy control group (95.2μmol/l v/s 86.2μmol/l, p<0.0001 and 4.6mmol/l v/s 4.1mmol/l, p<0.0001 respectively). The prevalence of pathological levels of serum creatinine, urea and sodium was higher in HIV-infected patients than HIV-negative participants (26.1% v/s 11.8%, p<0.0001; 4.4% v/s 0.5%, P<0.0001and 26.1% v/s 10.6%, p=0.001 respectively). Females experienced more serum creatinine disorders than their male counterparts (31.8% v/s 18.1%, p<0.0001). Age and antiretroviral treatment were not predictors of aberrations in levels of kidney function markers in HIV infected patients. AIDS defining CD4 depletion was associated with enhanced deterioration of kidney function. However, kidney function anomalies were not sufficient explanation for co-existing electrolyte anomalies as clinically altered creatinine states only correlated and co-varied with urea states (r =0.715) while sodium states co-varied with chloride levels (r = 0.296).Conclusion: Kidney function disorders are not infrequent in HIV infected individuals. Serum sodium aberration is observed more frequently in seropositive than in seronegative individuals. Routine review of kidney health status in local HIV infected individuals ought to be adopted for comprehensive management of HIV patients, more so among the female gender

Urine markers of kidney disorders and their risk associations in HIV-Infected patients attending Nyanza Provincial General Hospital in Kisumu, Western Kenya

Objective: To identify abnormal levels of urine metabolites and cells that serve as markers of existing kidney disorders in ambulatory HIV-infected patients.Design: A cross sectional study.Setting: Nyanza Provincial General Hospital’s patient support centre.Subjects: A total of 593 HIV infected patients were studied.Intervention: Dipstick urinalysis test was used to screen mid stream urine to detect constituents with altered levels.Results: Out of the 593 participants, the urine of 214 (36.1%) had abnormally altered levels of urine constituents, with more females afflicted than males [41.5% vs. 27.8%; OR 1.84 (1.28-2.63), χ2= 11.08, p=0.0009]. Urobilinogen was the most common urine metabolite while ketones were least commonly present. More participants had altered levels of leucocytes than erythrocytes in urine. Patients with pyuria were three times more likely to have elevated erythrocytes in their urine as well ( χ2= 34.37, p<0.0001). Similarly, the risk of having proteinuria was three times higher in patients with pyuria (p<0.0003, Fisher’s test). Patients with erythrocytes in urine also had a threefold likelihood of having proteinuria (P<0.0003, Fisher’s test). Fewer ARV users had abnormal urine markers [15.7% vs 24.3% OR 0.62 (0.41-0.94), χ2= 5.2, p<0.05].Conclusion: Metabolites and cellular markers of kidney disorders were prevalent in the urine of HIV patients especially females and those with pronounced immune depletion (CD4 counts equal to or below 500). ARVs use was associated with reduced manifestation of these markers

Effects Of Catha edulis’ Leaf Extract on Blood Chemistry and Kidney Tissues in Small East African Male Goats from Rift Valley Province of Kenya

Objectives: To determine the serum electrolytes levels in animals treated with Catha edulis leaf extract.Design: Experimental studySetting: Department of Biological Sciences at the Chepkoilel University College, Moi UniversitySubjects: Fourteen (14) reproductively mature and healthy small East African male goats (Capra aegagrus hircus) from Kerio Valley in Rift Valley province of Kenya.Intervention: Plasma electrolytes (Na+, K+, Ca2+ and Cl-), urea, creatine and glucose levels were investigated in eight control and fourteen experimental small East African male goats before and after treatment with Catha edulis leaf extracts. At the end of the study the animals’ were sacrificed and their kidneys extracted for histological examination.Results: mean sodium and calcium levels were lower in treated animals than nontreated animals (138 v/s 143.6 mmol/L and 3.3 v/s 2.2 mmol/L respectively), p<0.001 Plasma glucose levels also declined from  4.0-4.1mmol/L to 3.3-3.5mmol/L following the Catha edulis leaf extract treatment. However serum nitrogenous metabolites levels increased significantly in Catha edulis treated animals (urea; 6.5 v/s 5.2 mmol/L andcreatine; 69.9 v/s 55.4 mmol/L). Histological examination of renal tissue of Catha edulis treated animals revealed degenerative changes and hypercellularity in the glomeruli as well as interstitial inflammatory cell infiltration. Nuclei of proximal convoluted tubule cells also appeared pyknotic while those of the macula densa appeared granular.Conclusion: The present study showed that Catha edulis treatment was associated with electrolyte imbalance which may have been as a result of degenerative changes in the renal system. The findings are a pointer to the fact that Catha edulis use may predispose the users to renal disorders and subsequent electrolyte imbalance

Knowledge and Perceptions on Malaria and Its Association with Aquatic Habitats

Background: Malaria remains the major cause of morbidity and mortality among children in Kenya. About 70 percent of the population is at risk of infection, and roughly 34,000 young children die of malaria-related causes annually.Objective: To investigate the knowledge and perceptions of the local people for malaria in relation to aquatic habitats along the Kenyan Lake Victoria basin.Design: Community-based cross-sectional study.Setting: The Kenyan Lake Victoria basin Region.Subjects: Two hundred and fourty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding malaria.Results: Mosquitoes were perceived to be the main cause of malaria. Most respondents were familiar with the main signs and symptoms of mild malaria. Majority of the respondents had poor knowledge of mosquito breeding habitats with 45% mentioning the lake and only 18.6 and 8.9% mentioning ponds and dams, respectively. Most female respondents did not know the difference between mosquitoes and lake flies, P=0.03, Fishers exact test. The majority (97.5%) of the respondents reported seeking conventional malaria treatment from health institutions.Conclusion: Mosquitoes are perceived to be the main cause of malaria by both males and females. A significant proportion of the respondents were familiar with the main signs and symptoms of malaria and sought conventional medicine for treatment of the disease. Most of the respondents, however, had poor knowledge on the breeding habitats of mosquitoes. Concerted effort is needed to scale-up health education and improve the knowledge of the community about mosquitoes and their breeding habitats, particularly malaria vectors which do not breed in deep lake waters. Effective anti-malarial drugs should also be available at the grassroots level where the problem of malaria is rampant