East African medical journal最新文献

Background: 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.

Objective: 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).

Design: A combined retrospective and prospective cross-sectional study.

Setting: The University of Nairobi Dental Hospital (UNDH).

Subjects: All cases with a diagnosis of sarcoma registered between 2000-2009 were evaluated.

Results: 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.

Conclusion: 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.

Objective: 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.

Design: A cross sectional study.

Setting: 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.

Results: 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.

Conclusion: 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.

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.

Objective(s): 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.

Design: Cross-sectional study.

Subjects: 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.

Results: 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.

Conclusion: 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.

Objective: 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.

Design: Cross-sectional study.

Setting: Kenyatta National Hospital, Nairobi.

Subjects: 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.

Results: 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%).

Conclusions: 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.