Roles of DNA Molecules in Identification of Unclaimed or Missing Dead Bodies Presumed Death in Western Kenya Utilizing Comparison Standards

Medico-legal form bench-mark of health determinants and provide integrated services towards criminal justice support in health. Globally, over 44 million cases of unclaimed bodies or missing dead persons (UCBOMDPs) occur annually 88% of these cases are in Sub Saharan Africa. In Kenya and western Kenya rate of UCBOMDPs from road traffic accidents accounts 30% and 10% respectively 80% of these UCBOMDPs are associated with limited access to affordable quality comparison tests for identifications attributed to the increased prevalence of health and occupational hazards in population health. The current investigations aimed at identifying UCBOMDPs from public mortuaries by quantifying demographic data and determining DNA finger print and chemical tests (electrophoresis) using comparison standards. In Exploratory and cross sectional 235 respondents were investigated through purposive and saturated sampling using Finger print forms structured questionnaires focus group discussions (FGDs) observations and key informant interviews (KII) guides to collect data. Analyzed statistical inferences and contents analysis to saturation, results showed, 94% of mortuary service providers in tier 4 were primary and secondary education drop outs of males on contract jobs with limited access to quality services in mortuary science contrarily to females and males counterparts from tiers 5 and 6 mortuary facilities on permanent and trained. Rate of gross infection in public mortuaries and congestion had significant OD (2.2, 0.44). Prevalence of male being admitted as UCBOMDPs was significant due to being family bread winners OD (8.3, 0.12), RR (0.33), 95% CI (1.23, 1.02), significance were associated with male deliberately leaving IDs in houses due to identity. Utilization of Dactylography was significant than electrophoresis method, P value (0.67), OD (4.8, 1.3) due to high costs, procedures, DNA quantifying reagents and next of kin sampling for comparisons. Need for quality service advocacy in Department of Forensic Pathology to develop subsidized functional DNA chemical structures

Oesophageal and gastric toxoplasmosis: rare presentation of an emerging zoonotic disease

Background: Toxoplasmosis a Zoonotic disease caused by Toxoplasma gondii. Toxoplasma gondii (T. gondii) is a protozoan parasite that infects most species of warm blooded animals including humans. It is an obligate intracellular parasite with a worldwide distribution. Sporozoites exist in oocysts and are found in the gut walls of definitive hosts the cat family (Felidae). Cats become infected with T.gondii by carnivorism or indigestion of oocysts.Humans can become infected by any of the 4 routes; Eating undercooked meat of animals harbouring tissue cysts, Consuming food or water contaminated with cat feaces or by contaminated environmental samples (such as fecal contaminated soil or changing the litter box of a pet (cat), Blood transfusion or organ transplantation, Transplacentally (from mother to fetus), Accidental inoculation of tachyzoites.Ocular Toxoplasmosis, a major cause of Chorioretinitis , may be as a result of congenital toxoplasmosis or acquired infection. Congenitally infected patients can remain asymptomatic until the second or third decades of life. Congenital Toxoplasmosis is subclinical in about 75% of infected newborn.Case Study: E.K a 62 year old lady presented with a 3 months history of odynophagia that progressed to dysphagia. She had dyspepsia that was non-responsive to proton pump inhibitors. She gave history of slight weight loss due to inadequate food intake, because of the odynophagia, dysphagia and dyspepsia. She was in good general condition a febrile (Temp 37.10 C), not pale, no jaundice, no significant lymphadenopathy, nor oedema.Results: Recent findings have suggested an association between T. gondii infection and various Neurologic diseases or Psychiatric Syndromes such as Schistozophrenia, Alzheimer’s disease and Suicide. 10% to 20% of patients with acute infection may develop cervical lymphadenopathy or flulike illness.Recommendations: Many of these aspects of disease may be delayed or prevented if treatment of toxoplasmosis is initiated antenatally and in the first 1 – 2 months after delivery.Diagnosis and treatment must be different for each clinical category. In general, diagnosis accomplished using serology and histology. Isolation of the parasite can be difficult.Cconclusion: This being the first case in our literature, highliting the fact that; though rare oesophageal and gastric Toxoplasma infection can occur, leading to dysphagia and dyspepsia, Carnivorism of cats makes it difficult to keep them free of disease.Immunodeficiency patients often have Central Nervous System (CNS) disease but may have Pericarditis or Pneumonitis. Toxoplasmosis in immunodeficiency syndrome patients may be due to reactivation of chronic infection or acquired. Toxoplasmosis in patients being treated with immunosuppressive drugs may also be due to newly acquired or reactivated latent infection

CASE REPORT - Reactivated toxoplasmosis presenting with non-tender hepatomegaly in a patient with HIV infection

No Abstract African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 97-9

Attitude and practice of health care providers towards autopsies in children under five years at Kenyatta National Hospital

Background: Attitude and practice of health care professionals toward autopsy are important as they will give information regarding factors that contribute to the low rate of autopsies in children under five years.Objective: To evaluate the attitude and practice of health care providers towards autopsies in children under five years.Design: Cross-sectional hospital based descriptive survey.Setting: General paediatrics wards and newborn unit at Kenyatta National Hospital, Nairobi, Kenya.Subjects: Health care providers working at the Kenyatta National Hospital paediatric wards and newborn unit.Results: The study enrolled 95 health care providers. Majority (69.5%) of health care providers showed a positive attitude towards autopsy. Consultants and paeadiatric residents had a more positive attitude compared to interns (p< 0.001) and nurses (p=O.Oll). Clinical experience of> 15 years was associated with a more positive attitude. The main barriers to obtaining consent were lack of formal training in obtaining consent and failure of autopsy results to be availed in a timely manner.Conclusions: Health care providers had a positive attitude to autopsy which was significantly associated with their cadre and years of experience. The main reasons given for not obtaining consent for autopsy were lack of formal training in obtaining consent and failure to obtain autopsy results in timely manner

Ogilvie’s syndrome: case report of spontaneous rupture of the ceacum following caesarean section

In acute colonic pseudo-obstruction (ACPO) there is colonic distension without an organic obstacle (intrinsic or extrinsic to intestinal wall). This becomes a potential site of ceacal rapture which can lead to the demise of the patient. Presented is a case of a mother who had spontaneous caecal rapture five days after Caesarean delivery. At Laparotomy the ceacal rapture was confirmed and a colostomy was done. The patient succumbed in Intensive care unit two days post-operatively

Correlation of EGFR, pEGFR and p16INK4 expressions and high risk HPV infection in HIV/AIDS-related squamous cell carcinoma of conjunctiva

Background: Squamous cell carcinoma of conjunctiva has increased tenfold in the era of HIV/AIDS. The disease pattern has also changed in Africa, affecting young persons, with peak age-specific incidence of 30-39 years, similar to that of Kaposi sarcoma, a well known HIV/AIDS defining neoplasm. In addition, the disease has assumed more aggressive clinical course. The contributing role of exposure to high risk HPV in the development of SCCC is still emerging. Objective. The present study aimed to investigate if immunohistochemical expressions of EGFR, pEGFR and p16, could predict infection with high risk HPV in HIV-related SCCC. Methods. FFPE tissue blocks of fifty-eight cases diagnosed on hematoxylin and eosin with SCCC between 2005-2011, and subsequently confirmed from medical records to be HIV positive at the department of human pathology, UoN/KNH, were used for the study. Immunohistochemistry was performed to assess the expressions of p16INK4A, EGFR and pEGFR. This was followed with semi-nested PCR based detection and sequencing of HPV genotypes. The sequences were compared with the GenBank database, and data analyzed for significant statistical correlations using SPSS 16.0. Ethical approval to conduct the study was obtained from KNH-ERC. Results: Out of the fifty-eight cases of SCCC analyzed, twenty-nine (50%) had well differentiated (grade 1), twenty one (36.2%) moderately differentiated (grade 2) while eight (13.8%) had poorly differentiated (grade 3) tumours. Immunohistochemistry assay was done in all the fifty eight studied cases, of which thirty nine cases (67.2%) were positive for p16INK4A staining, forty eight cases (82.8%) for EGFR and fifty one cases (87.9%) showed positivity for p-EGFR. HPV DNA was detected in 4 out of 40 SCCC cases (10%) in which PCR was performed, with HPV16 being the only HPV sub-type detected. Significant statistical association was found between HPV detection and p16INK4 (p=0.000, at 99% C.I) and EGFR (p=0.028, at 95% C.I) expressions, but not pEGFR. In addition, the expressions of these biomarkers did not show any significant association with tumor grades. Conclusion: This study points to an association of high risk HPV with over expressions of p16INK4A and EGFR proteins in AIDS-associated SCCC. © 2014 Mwololo et al.; licensee BioMed Central Ltd

Virus-encoded microRNA contributes to the molecular profile of EBV-positive Burkitt lymphomas

Burkitt lymphoma (BL) is an aggressive neoplasm characterized by consistent morphology and phenotype, typical clinical behavior and distinctive molecular profile. The latter is mostly driven by the MYC over-expression associated with the characteristic translocation (8;14) (q24; q32) or with variant lesions. Additional genetic events can contribute to Burkitt Lymphoma pathobiology and retain clinical significance. A pathogenetic role for Epstein-Barr virus infection in Burkitt lymphomagenesis has been suggested; however, the exact function of the virus is largely unknown.In this study, we investigated the molecular profiles (genes and microRNAs) of Epstein-Barr virus-positive and -negative BL, to identify specific patterns relying on the differential expression and role of Epstein-Barr virus-encoded microRNAs.First, we found significant differences in the expression of viral microRNAs and in selected target genes. Among others, we identified LIN28B, CGNL1, GCET2, MRAS, PLCD4, SEL1L, SXX1, and the tyrosine kinases encoding STK10/STK33, all provided with potential pathogenetic significance. GCET2, also validated by immunohistochemistry, appeared to be a useful marker for distinguishing EBV-positive and EBV-negative cases. Further, we provided solid evidences that the EBV-encoded microRNAs (e.g. BART6) significantly mold the transcriptional landscape of Burkitt Lymphoma clones.In conclusion, our data indicated significant differences in the transcriptional profiles of EBV-positive and EBV-negative BL and highlight the role of virus encoded miRNA

Lymphomas in sub-Saharan Africa - what can we learn and how can we help in improving diagnosis, managing patients and fostering translational research?

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team of lymphoma experts on 159 fine needle aspirate samples and 467 histological samples during their visit to selected sub- Saharan African centres is presented. Among children (age), BL accounted for 82% of all NHL, and among adults, diffuse large B-cell lymphoma accounted for 55% of all NHLs. Among adults, various lymphomas other than BL, including T-cell lymphomas, were encountered. The review also discusses the current strategies of the International Network of Cancer Treatment and Research on improving the diagnostic standards and management of lymphoma patients and in acquiring reliable clinical and pathology data in sub- Saharan Africa for fostering high-quality translational research

Colonic Pathology in Nairobi, Kenya: A review of colonoscopic and HistopathologicaL Profiles of 418 patients

Background: Symptoms of digestive disorders are among the most common causes of consultations to health workers worldwide. But from Sub.Saharan African there is a shortage of information on morphological profiles, morbidity, mortality and epidemiology of digestive disease. The aim of this study was to do a retrospective analysis of records on colonoscopic findings and histological examination of patients evaluated between 2005 and 2011 with aim of establishing the profiles and characteristics of colonic lesions seen in Kenya. Methodology: Records of patients sent for colonoscopy in a busy private clinic were reviewed retrospectively. The records reviewed included patients demographic data, appearance of colon at colonoscopy and histological findings of biopsied samples. The records were retrieved from the clinic and the laboratory files and entered into an EXEL spread sheet. The data was cleaned and analyzed using SPSS Version 17. The patients had been referred from both public and private hospitals countrywide. Results: Four hundred and eighteen patients were seen over the 6 years; 247 male and 171 female (ratio 1.4:1) mean age for the entire group population was 45± 20 years. Of these 10.8% were normal, 51.9% were non.specific colitis, 12.7% Adenocarcinoma, 9.3% Ulcerative colitis and 7.7% amoebic colitis. Well differentiated adenocarcinoma was the commonest neoplasm, the most frequent histopathological pattern in this category. Conclusion: Ulcerative colitis and Amoeabic colitis and cancer of the colon are frequent and appear to be on the increase

Vulvo-perianal giant condylomata accuminata (Buschke Lowenstein Tumor) in a HIV-infected woman: a case report

Giant condylomata accuminata also known as Buschke Lowenstein Tumor (BLT) is a benign extensive cauliflower like lesion that is commonly found in the genital area. Its etiology is human pappiloma virus. It occurs more in men than women with a ratio of 2.7:1. Immunosuppresssion with HIV is the main risk factor but it has also been associated with pregnancy, diabetes, chronic steroid use and organ  transplants. It is debilitating with extensive psychosocial maladjustments and has 50% potential for  malignant transformation. The study was undertaken at Kenyatta National Hospital Gynecological ward. A 37 year old Para 2+0, HIV-infected woman on Highly Active Antiretroviral Therapy (HAART) for the past eight years, presented with a seven year history of progressive vulval growths and a five year history of per vaginal discharge and pruritus. The growths were insidious in onset and progressive but with no associated pain. The discharge was yellow, watery, copious and not foul smelling. There was no history of dyspareunia or post coital bleeding. She had been treated with various creams and antibiotics with no improvement. The physical examination revealed extensive cauliflower vulvo-vaginal and perianal warts with confluence in the mons pubis and labia majora  bilaterally. The lesions appeared flat and brownish- black, and of variable diameter ranging from 0.5cm to 3cm. The lesions were not friable and did not bleed upon touch. Due to the extensive nature of the lesions, a decision to undertake simple vulvectomy was made. The patient was consented for the surgery, wide excision was done with successful primary closure of wound site. Histopathology results confirmed giant condylomata acuminata, with no malignant changes noted and free margins. The wound healed by primary intention within one week of surgery. At one year follow up, the patient was still on HAART, no recurrence of the vulval lesions and a Pap smear cytology report was normal. She was advised on condom use, adherence to HAART and on the  importance of sustained follow up. We concluded that HIV-infected women on HAART are at risk for BLT, a severe disease associated with malignant transformation, vulvo-perineal examination should be scheduled into routine follow up for early diagnosis and treatment