East African medical journal最新文献

{"title":"TYPES OF ALBINISM IN THE BLACK SOUTHERN AFRICA POPULATION.","authors":"J. Kromberg, J. Bothwell, S. Kidson, P. Manga, R. Kerr, T. Jenkins","doi":"10.4314/EAMJ.V89I1","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I1","url":null,"abstract":"BACKGROUND Oculocutaneous albinism (OCA) is the most common inherited disorder in Southern African blacks and several types have been described. Molecular techniques, where available, can be used to confirm a clinical diagnosis and the type of OCA, if necessary, and for prenatal diagnosis. OBJECTIVES To investigate and classify the different types of albinism commonly found and to determine the clinical implications for each type. DESIGN A descriptive survey. SETTING Gauteng province, South Africa, and Lesotho. SUBJECTS Three groups of subjects with OCA (96 from a genetics clinic, 62 from a dermatology clinic, and 31 from community surveys) from the black African population participated. MAIN OUTCOME MEASURES Subjects underwent clinical and/or dermatological examinations and were then classified according to type of OCA. RESULTS Four forms of OCA were identified: most (82%) subjects had OCA2 (a tyrosinase- positive type) with three sub-types: those without large freckles (ephelides) on exposed areas (named OCA 2a in this study), those with such freckles (named OCA 2b), and those with brown albinism (BOCA); the remainder had red/rufous albinism, ROCA (OCA 3). The four forms could be distinguished from each other clinically without using molecular genetic testing. CONCLUSION The most common types of albinism found in the black population of Southern Africa are OCA2 and OCA3. Given the high prevalence of the disorder, together with the high risk of skin cancer, and the recent persecution of affected individuals in certain East African countries, these findings and their clinical implications have significance in terms of both education and awareness for health professionals and lay people caring for those with albinism.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"89 1 1","pages":"20-7"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AN UNUSUAL PRESENTATION OF ACUTE LYMPHOBLASTIC LEUKAEMIA WITH PERI-CARDIAL EFFUSION CAUSING CARDIAC TAMPONADE.","authors":"L. Mutai, F. Abdallah, F. Kaiser","doi":"10.4314/EAMJ.V89I4","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I4","url":null,"abstract":"Peri-cardial effusion is most commonly associated with tuberculous infection in the developing world. Peri-cardial effusion causes symptoms when it is large or when it has accumulated rapidly. Non-tuberculous causes of peri-cardial effusion include bacterial infections, uraemia, viral infections, rheumatic fever, connective tissue disorders, post - peri-cardiotomy syndromes and malignancy. We present a case of acute lymphoblastic leukaemia first presenting as a large peri-cardial effusion causing tamponade.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"89 4 1","pages":"142-3"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycobacterium Tuberculosis Genetic Diversity and Drug Resistance Conferring Mutations in the Democratic Republic of the Congo","authors":"L. Fenner, S. Gagneux, G. Kabuya, David Stucki, Jp Kabuayi, S. Borrell, R. Frei, C. Burri, D. Kalemwa, M. Egger, Jp Okiata","doi":"10.7892/BORIS.73716","DOIUrl":"https://doi.org/10.7892/BORIS.73716","url":null,"abstract":"Background: The Democratic Republic of the Congo (DRC) belongs to the 22 tuberculosis (TB) high-burden countries and to the 27 high-burden multidrug-resistant (MDR)-TB countries. To date, there are no data on the genetic diversity of Mycobacterium tuberculosis in the DRC. Objective: To describe the genetic diversity and the distribution of drug resistance conferring mutations of clinical M. tuberculosis isolates from the DRC. Design: We analysed consecutive M. tuberculosis single patient isolates cultured in 2010 at the laboratory of the National TB Control Programme in Kinshasa. Setting: National TB Control Programme in Kinshasa, DRC. Results: Isolates from 50 patients with pulmonary TB were analysed, including 45 patients (90%) who failed treatment. All isolates belonged to the Euro-American lineage (main phylogenetic Lineage 4). Six different spoligotype families were observed within this lineage, including LAM (20 patients, 40%), T (15 patients; 30%), U (4 patients; 8%), S (3 patients; 6%), Haarlem (2 patients; 4%), and X (1 patient; 2%). No M. africanum strains were observed. The most frequently detected drug  resistance-conferring mutations were rpoB S531L and katG S315T1. Various other mutations, including previously unreported mutations, were detected. Conclusions: The Euro-American lineage dominates in the DRC, with substantial variation in spoligotype families. This study fills an important gap on the molecular map of M. tuberculosis in sub-Saharan Africa.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 1","pages":"409-415"},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71358009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic ureteric injuries in a Nigerian Teaching Hospital- experience in the last decade","authors":"K. Tijani, K. Onwuzurigbo, R. Ojewola, B. Afolabi, N. Akanmu","doi":"10.4314/EAMJ.V88I9","DOIUrl":"https://doi.org/10.4314/EAMJ.V88I9","url":null,"abstract":"Background: Ureteric injury is one of the most serious complications of any abdominal or pelvic surgery with significant morbidity. The medico-legal consequences are also becoming areas of concern in our environment. Traditionally abdominal hysterectomy was responsible for most cases. While recent reports from the west have however indicated a change in the pattern of these iatrogenic injuries with urological endoscopy being the major source, recent literature from the sub-Saharan Africa is relatively sparse, with the few ones available also indicating a change in pattern however of a different variety with a high incidence of injuries arising from gynaecological, non-hysterectomy causes. Objectives: To determine the incidence, pattern of presentation and outcome managements of iatrogenic ureteric injuries in our centre. Design: A retrospective descriptive study. Setting: Lagos University Teaching Hospital, Lagos, Nigeria. Subjects: Twenty patients managed for iatrogenic ureteric injuries between January 2000 and June 2010. Results: A total of 20 patients were managed for 24 iatrogenic injuries. Total abdominal hysterectomy was responsible for 15 (75%) of the patients. Six patients had the injury from the referring hospital in four of whom the gynaecological operations were performed by general practitioners (GP). Twelve patients developed injury after operation in our centre. Excessive intra-operative bleeding and emergency surgery in critically ill patients referred by the GP or traditional birth attendants were the most common predisposing factors. All but one patient had open surgical intervention. All patients with delayed diagnosis were operated immediately they were fit for anaesthesia irrespective of the time of injury. Outcome was satisfactory in all patients who had surgical intervention. There was one mortality whic h occurred in one patient who presented late and died before surgical intervention. Conclusion: Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Open surgical intervention gives satisfactory results in all cases. Early surgical intervention is necessary to prevent morbidity and mortality.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 1","pages":"304-309"},"PeriodicalIF":0.0,"publicationDate":"2011-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-histopathologic types of maxillofacial malignancies with emphasis on sarcomas: a 10-year review.","authors":"M W Kamau,&nbsp;M L Chindia,&nbsp;E A O Dimba,&nbsp;D Awange,&nbsp;L Gathece","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Sarcomas are malignant neoplasms that occur anywhere in the human body. Though their occurrence in the head and neck region is rare vis-a-vis other malignancies, their presence is of tremendous concern due to their often grave prognosis.</p><p><strong>Objective: </strong>To determine the pattern of occurrence, histopathologic types of maxillofacial sarcomas and their proportion to other malignant neoplasms of this region based on archival material accumulated over 10 years (2000-2009).</p><p><strong>Design: </strong>A combined retrospective and prospective cross-sectional study.</p><p><strong>Setting: </strong>The University of Nairobi Dental Hospital (UNDH).</p><p><strong>Subjects: </strong>All cases with a diagnosis of sarcoma registered between 2000-2009 were evaluated.</p><p><strong>Results: </strong>Of the 528 malignancies recorded over the ten-year period, 427 (80.9%) were of epithelial origin while 101 (19.1%) were sarcomas. Patients with epithelial malignancies were older (54.16 +/- 15.94 years) than patients with sarcomas (31.73 +/- 16.78) with the differences having been statistically significant. Osteosarcoma was the most commonly occurring sarcoma (29.7%), followed by Kaposi's sarcoma (KS) (28.7%), fibrosarcoma (FBS) (18.8%), and rhabdomyosarcoma (RMS) (9.9%). Sarcomas peaked in the third decade with 70% occurring below the age of 40 years. The maxilla and the mandible were the most afflicted sites in the maxillofacial region accounting for 52%. The patients on average presented to medical personel about nine months after noticing the lesion with the most frequent complaint having been swelling.</p><p><strong>Conclusion: </strong>The present study confirms the relative rarity of maxillofacial sarcomas. It also provides data on the histopathologic types and demographic characteristics of maxillofacial sarcomas in a select Kenyan population. This information is a contribution to the comprehensive documentation of sarcomas that occur globally and is useful in the provision of baseline data upon which future prospective analytical protocols may arise.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 2","pages":"39-45"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32456886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial contamination of kale (Brassica oleracea Acephala) along the supply chain in Nairobi and its environment.","authors":"E K Kutto,&nbsp;M W Ngigi,&nbsp;N Karanja,&nbsp;E Kange'the,&nbsp;L C Bebora,&nbsp;C J Lagerkvist,&nbsp;P G Mbuthia,&nbsp;L W Njagi,&nbsp;J J Okello","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the microbiological safety of kale (Brassica oleracea Acephala) produced from farms and those sold at the markets with special focus on coliforms, E.coli and Salmonella.</p><p><strong>Design: </strong>A cross sectional study.</p><p><strong>Setting: </strong>Peri-Urban farms (in Athi River, Ngong and Wangige), wet markets (in Kawangware, Kangemi and Githurai), supermarkets and high-end specialty store both within Nairobi city.</p><p><strong>Results: </strong>Mean coliform count on vegetables from farms were 2.6 x 10(5) +/- 5.0 x 10(5) cfu/g while those from the wet markets were 4.6 x 10(6) +/- 9.1 x 10(6) cfu/g, supermarkets, 2.6 x 10(6) +/- 2.7 x 10(6) and high-end specialty store 4.7 x 10(5) +/- 8.9 x 10 (5). Coliform numbers obtained on kales from the wet markets and supermarkets were significantly higher (p < 0.05) compared to those from farms, while kale samples purchased from high-end specialty store had similar levels of coliform loads as those from the farms. E. coli prevalence in the wet markets, supermarkets and high-end specialty store were: 40, 20 and 20%, respectively. Salmonella was detected on 4.5 and 6.3% of samples collected from the farms in Wangige and wet market in Kawangware, respectively. Fecal coliforms in water used on farms (for irrigation) and in the markets (for washing the vegetables) exceeded levels recommended by World Health Organization (WHO) of 10(3) organisms per 100 milliliter while Salmonella was detected in 12.5% of washing water samples collected from Kangemi market.</p><p><strong>Conclusion: </strong>Poor cultivation practices and poor handling of vegetables along the supply chain could increase the risk of pathogen contamination thus puting the health of the public at risk, therefore good agricultural and handling practices should be observed.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 2","pages":"46-53"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32458928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial myxoma: case report and literature review.","authors":"J Nwiloh,&nbsp;M Oludara,&nbsp;P Adebola","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Myxomas are the most common cardiac neoplasm accounting for 50% of all tumours. Usually symptomatic at diagnosis, the advent of routine echocardiogram in clinical practice has enabled earlier diagnosis before onset of symptoms. There however have been few reports in black Africans, and so we are reporting a male patient who presented with heart failure secondary to a large left atrial myxoma mimicking mitral stenosis from diastolic flow obstruction across the valve. He underwent successful resection and to the best of our knowledge is the first reported resected surgical case in Nigeria.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 2","pages":"71-2"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32458934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Willingness to pay for voluntary health insurance in Tanzania.","authors":"A Kuwawenaruwa,&nbsp;J Macha,&nbsp;J Borghi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective(s): </strong>To assess how willing people would be to join a voluntary health insurance scheme and to see how they respond to changes in the benefit package. We also examined willingness to cross-subsidise the poor.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Subjects: </strong>Two thousand two hundread and twenty four households comprising of 1,163 uninsured household heads asked about their willingness to pay for insurance in seven districts/councils (three urban and four rural) and 1,061 insured households were asked about their willingness to pay for insurance premiums for the poor in their community. Uninsured respondents were presented with two scenarios, the first reflected the current design of the Community Health Fund/Tiba Kwa Kadi (CHF/TIKA), the second offered expanded benefits, and included inpatient care in public facilities and transport.</p><p><strong>Results: </strong>Only 30% of uninsured rural households were willing to pay more than Tsh 5,000 the current premium level, their average amount was Tsh 10,741, while in urban areas one percent of households were willing to pay more than Tsh 5,000. There was very limited willingness to pay more than 5,000 Tsh, even with an expanded package in rural areas. Household from rural areas were more willing to cross-subsidise the poor, but contribution levels were higher in urban areas.</p><p><strong>Conclusion: </strong>Communities need to be sensitised about the existence of the CHF/TIKA to encourage enrollment. Expanding the benefit package would further increase enrollment. However, few people would be willing to pay more than the current premium.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 2","pages":"54-64"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32458930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of WHO clinical staging with CD4 counts in adult HIV/AIDS patients at Kenyatta National Hospital, Nairobi.","authors":"C S Ilovi,&nbsp;G N Lule,&nbsp;A O Obel,&nbsp;H M Irimu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To determine the degree of correlation between the WHO clinical staging and CD4 T-cell counts in HIV/AIDS adults at Kenyatta National Hospital, Nairobi.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Kenyatta National Hospital, Nairobi.</p><p><strong>Subjects: </strong>One hundread and fifty two newly diagnosed HIV patients were recruited prospectively. Patients were first staged using the 2005 WHO clinical staging and then blood drawn for CD4 cell count.</p><p><strong>Results: </strong>The mean age in the study was 35 years, with females comprising 52.6% of the study group. The mean CD4 counts were 455, 420, 203 and 92 for WHO Stage 1, 2, 3 and 4 respectively. The sensitivity of the WHO clinical staging to predict CD4 counts of > 350 cells/microl was 63% with a specificity of 82%. The most common HIV clinical events were bacterial infections (33%), severe weight loss (28%) and tuberculosis (27%).</p><p><strong>Conclusions: </strong>There was correlation between the WHO clinical staging and expected CD4 T-cell count. However, the sensitivity was low and missed over a third of the patients in need of HAART. Majority of the patients presented in severe disease in need of HAART at the onset of their HIV diagnosis with 107 (70.3%) of the patients with Stage 3 or 4 disease and 114 (75%) of patients with CD4 counts of < 350 cells/microl.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 2","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32458931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral cancer: a growing concern.","authors":"K Koech","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"88 2","pages":"37-8"},"PeriodicalIF":0.0,"publicationDate":"2011-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32456884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}