Prevalence of low back pain amongst workers at a paediatric Hospital in Nairobi

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Thrombocytopenia in Haart naive HIV infected patients attending the comprehensive care clinic at Kenyatta national hospital

Background: Haematological abnormalities are common in HIV infected patients. Thrombocytopenia has been associated with progression of disease. The presence of thrombocytopenia is significantly associated with decreased survival and is a predictor of mortality.Objective: To determine the prevalence of thrombocytopenia and clinical characteristics of HIV infected patients who are HAART naive attending the Kenyatta National Hospital Comprehensive Care Clinic..Design: Cross-sectional descriptive Study.Setting: Kenyatta National Hospital Comprehensive Care Clinic.Subjects: HIV positive HAART naive patients.Results: Three hundred and forty HIV infected HAART naive patients with a mean age of 37.3years and range of 18years to 72years were recruited. The male to female ratio was 1:1.6.The study population comprised mostly of; young patients (39.9% between 30-40yrs), females (61.6%) in WHO clinical stage I (57.6%) and with CD4 count between 200-500 cell/mm3. The mean platelet count was 230,000 cells/ul. The prevalence of thrombocytopenia in this population was 3.8%. Most of the patients (66.7%) with thrombocytopenia had a bicytopenia with the rest having isolated thrombocytopenia or pancytopenia. Bleeding tendencies were observed more in the thrombocytopenia group (p= 0.011). Patients with CD4 count < 200cells/mm3 were more likely to have thrombocytopenia (p <0.050).Conclusion: The prevalence of thrombocytopenia is low among ambulant HIV infected HAART naive patients attending the Kenyatta National Hospital Comprehensive Care Clinic. This could be attributed to young age, predominant female gender and early disease WHO Stage 1 in the study population. Other studies found older age, male gender and advanced HIV infection population to be determinants where higher prevalence of thrombocytopenia have been reported

ADAPTATION OF INTRODUCED MUNGBEAN GENOTYPES IN UGANDA

Mungbean ( Vigna radiata (L.) Wilczek) is an important source of nutrients and income for smallholder farmers in East Africa. Mungbean production in countries like Uganda largely depends on landraces, in the absence of improved varieties. In order to enhance productivity, efforts have been underway to develop and evaluate mungbean varieties that meet farmers\u2019 needs in various parts of the country. This study was conducted at six locations in Uganda, to determine the adaptability of introduced mungbean genotypes, and identify mungbean production mega-environments in Uganda. Eleven genotypes (Filsan, Sunshine, Blackgram, Mauritius1, VC6148 (50-12), VC6173 (B-10),Yellowmungo, KPS1, VC6137(B-14),VC6372(45-60),VC6153(B-20P) and one local check were evaluated in six locations during 2013 and 2014. The locations were; National Semi Arid Resources Research Institute (NaSARRI), Abi Zonal Agricultural Research and Development Institute (AbiZARDI),Kaberamaido variety trial center, Kumi variety trial center, Nabuin Zonal Agricultural Research and Development Institute (NabuinZARDI), and Ngetta Zonal Agricultural Research and Development Institute (NgettaZARDI). G 7 E interactions were significant for grain yield. Through GGEBiplot analysis, three introduced genotypes (Filsan, Blackgram and Sunshine) were found to be stable and high yielding, and therefore, were recommended for release. The six test multi-locations were grouped into two candidate mega-environments for mungbean production (one comprising of AbiZARDI and Kaberamaido and the other comprising of NaSARRI, NabuinZARDI, Kumi, and NgettaZARDI). National Semi Arid Resources Research Institute (NaSARRI) was the most suitable environment in terms of both discriminative ability and representativeness and therefore can be used for selection of widely adaptable genotypes.La f\ue8ve ( Vigna radiata (L.) Wilczek) est une importante source de nutriments et de revenu pour les paysans en Afrique de l\u2019Est. La production de la f\ue8ve dans des pays comme Ouganda d\ue9pend largement des vari\ue9t\ue9s locales, \ue0 d\ue9faut des vari\ue9t\ue9s am\ue9lior\ue9es. Dans le but d\u2019accroitre la productivit\ue9, des efforts ont \ue9t\ue9 fournis pour d\ue9velopper et \ue9valuer les vari\ue9t\ue9s de f\ue8ves pouvant satisfaire les besoins des producteurs dans diff\ue9rents coins du pays. La pr\ue9sente \ue9tude a \ue9t\ue9 conduite dans six emplacements en Ouganda, en vue de d\ue9terminer l\u2019adaptabilit\ue9 de vari\ue9t\ue9s introduites de f\ue8ves et identifier les zones majeures de production de f\ue8ves. Onze vari\ue9t\ue9s introduites (Filsan, Sunshine, Blackgram, Mauritius1, VC6148 (50-12), VC6173 (B-10),Yellowmungo, KPS1, VC6137(B-14),VC6372(45-60),VC6153(B-20P) et une vari\ue9t\ue9 locale utilis\ue9e ici comme t\ue9moin, ont \ue9t\ue9 \ue9valu\ue9es dans six emplacements au cours des ann\ue9es 2013 et 2014. Les emplacements \ue9taient\ua0: l\u2019Institut Nationale de Recherche sur les Ressources Semi-Aride (NaSARRI), l\u2019Institut Zonale de Recherche Agricole et D\ue9veloppement de Abi (AbiZARDI), le centre d\u2019exp\ue9rimentation des vari\ue9t\ue9s de Kaberamaido, le centre d\u2019exp\ue9rimentation des vari\ue9t\ue9s de Kumi, l\u2019Institut Zonale de Recherche Agricole et D\ue9veloppement de Nabuin (NabuinZARDI) et l\u2019Institut Zonale de Recherche Agricole et D\ue9veloppement de Ngetta (NgettaZARDI). L\u2019interaction g\ue9notypes et environement G 7 E \ue9tait significatif pour le rendement en grain. Une analyse se servant de biplot, a r\ue9v\ue9l\ue9 trois stables vari\ue9t\ue9es introduites (Filsan, Blackgram and Sunshine), ayant des rendements \ue9lev\ue9s. Ces trois vari\ue9t\ue9es sont donc recommend\ue9es pour \ueatre lanc\ue9es. Les six emplacements utilizes dans cette \ue9tude peuvent \ueatre group\ue9s en deux grandes zones proprices \ue0 la production de la f\ue8ve (la premi\ue8re zone est constitu\ue9e de AbiZARDI et Kaberamaido, tandis que la seconde est faite de NaSARRI, NabuinZARDI, Kumi et NgettaZARDI). NaSARRI s\u2019est r\ue9v\ue9l\ue9 l\u2019emplacement le plus propice, en ce sens que cet emplacement \ue9tait le plus discriminant et le plus repr\ue9sentatif, et de ce fait peut \ueatre utilis\ue9 pour s\ue9lectionner des vari\ue9t\ue9es \ue0 large adaptation

Nephropathy in patients with recently diagnosed type 2 diabetes mellitus black Africans

Background: Albuminuria is long recognised as a sign of renal disease in diabetes. In type 1 diabetes, renal disease occurs after a longer duration of diabetic state. In type 2 diabetes, it is more variable. Objective: To determine the prevalence and any risk factors of albuminuria in short­ term (≤2 yrs) type 2 diabetes. Design: Cross sectional, descriptive study. Microalbuminuria was assessed using micro II strips. Setting: Outpatient diabetic clinic at Kenyatta National Hospital, Nairobi. Subjects: Patients who were newly diagnosed or had had type 2 diabetes for two years or less. Main outcome measures: Microalbuminuria, lipids, glycated haemoglobin, fasting blood glucose and blood pressure. Results: One hundred and thirty nine patients who had type 2 diabetes mellitus for ≤2 yrs were seen, but only 100 patients were included in the study over a six month period. Their mean (SD) age was 53.7 (9.3) years. Mean (SD) duration of diabetes was 10.3 (7.5) months. Fifty per cent of the study patients were hypertensive. Only 48% had HbAic \u3c8% while 36% had HbAic \u3e9%. The lipid profile of total, LDL - HDL­ cholesterol and triglycerides were predominantly within normal limits. Twenty six per cent were established to have albuminuria of which one patient had macroalbuminuria. Blood pressure, glycated haemoglobin and lipid parameters were not significantly different from patients without albuminuria Conclusion: Albuminuria occurred in a significant proportion of patients with short term type 2 diabetes. Comparable to studies done elsewhere on short-term type 2 diabetes, albuminuria is both a sign of nephropathy and a cardiovascular risk factor. It should be looked for in all patients with type 2 diabetes attending this clinic, even at diagnosis

Neandertals and modern humans in Western Asia.

Edited by Takeru Akazawa, Kenichi Aoki, and Ofer Bar-Yosef. 1998. New York: Plenum Press. 552 pp. ISBN 0-306-45924-8. $79.50 (cloth).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34265/1/10_ftp.pd

Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

Background: Data on biochemical markers and their association with mortality rates in patients with severe coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in sub-Saharan Africa are scarce. An evaluation of baseline routine biochemical parameters was performed in COVID-19 patients admitted to the ICU, in order to identify prognostic biomarkers. Methods: Demographic, clinical, and laboratory data were collected prospectively from patients with PCR-confirmed COVID-19 admitted to the adult ICU of a tertiary hospital in Cape Town, South Africa, between October 2020 and February 2021. Robust Poisson regression methods and the receiver operating characteristic (ROC) curve were used to explore the association of biochemical parameters with severity and mortality. Results: A total of 82 patients (median age 53.8 years, interquartile range 46.4–59.7 years) were enrolled, of whom 55 (67%) were female and 27 (33%) were male. The median duration of ICU stay was 10 days (interquartile range 5–14 days); 54/82 patients died (66% case fatality rate). Baseline lactate dehydrogenase (LDH) (adjusted relative risk 1.002, 95% confidence interval 1.0004–1.004; P = 0.016) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (adjusted relative risk 1.0004, 95% confidence interval 1.0001–1.0007; P = 0.014) were both found to be independent risk factors of a poor prognosis, with optimal cut-off values of 449.5 U/l (sensitivity 100%, specificity 43%) and 551 pg/ml (sensitivity 49%, specificity 86%), respectively. Conclusions: LDH and NT-proBNP appear to be promising predictors of a poor prognosis in COVID-19 patients in the ICU. Studies with a larger sample size are required to confirm the validity of this combination of biomarkers

Haematological predictors of poor outcome among COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

BACKGROUND: Studies from Asia, Europe and the USA indicate that widely available haematological parameters could be used to determine the clinical severity of Coronavirus disease 2019 (COVID-19) and predict management outcome. There is limited data from Africa on their usefulness in patients admitted to Intensive Care Units (ICUs). We performed an evaluation of baseline haematological parameters as prognostic biomarkers in ICU COVID-19 patients. METHODS: Demographic, clinical and laboratory data were collected prospectively on patients with confirmed COVID-19, admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between March 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curves were used to explore the association of haematological parameters with COVID-19 severity and mortality. RESULTS: A total of 490 patients (median age 54.1 years) were included, of whom 237 (48%) were female. The median duration of ICU stay was 6 days and 309/490 (63%) patients died. Raised neutrophil count and neutrophil/lymphocyte ratio (NLR) were associated with worse outcome. Independent risk factors associated with mortality were age (ARR 1.01, 95%CI 1.0–1.02; p = 0.002); female sex (ARR 1.23, 95%CI 1.05–1.42; p = 0.008) and D-dimer levels (ARR 1.01, 95%CI 1.002–1.03; p = 0.016). CONCLUSIONS: Our study showed that raised neutrophil count, NLR and D-dimer at the time of ICU admission were associated with higher mortality. Contrary to what has previously been reported, our study revealed females admitted to the ICU had a higher risk of mortality

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Platelet function in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi, Kenya

Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. Results: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 ± 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. Conclusion: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness. (East African Medical Journal: 2002 79(8): 405-407