African
Journals OnLine
East African Medical Journal
Volume 79, No 8, August 2002
Abstracts
NEPHROPATHY IN PATIENTS WITH
RECENTLY DIAGNOSED TYPE 2 DIABETES MELLITUS IN BLACK AFRICANS
F.W. Wanjohi, MBBS (Milan), MMed (Nbi), Registrar in
Internal Medicine, Aga Khan Hospital, P.O. Box 30270, Nairobi, F.C.F.
Otieno, MBChB, MMed (Nbi), E. N. Ogola, MBChB, MMed (Nbi), Associate
Professor and Chairman and E.O. Amayo, MBChB, MMed (Nbi), Senior
Lecturer, Department of Medicine, College of Health Sciences,
University of Nairobi, P.O. Box 19676, Nairobi, Kenya
Request for reprints to: Dr. F.C.F.
Otieno, Department of Medicine, College of Health Sciences, University
of Nairobi, P.O. Box 19676, Nairobi, Kenya
ABSTRACT
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 shortterm
(<2
yrs) type 2 diabetes.
Design:
Cross sectional, descriptive study. Microalbuminuria was
assessed using 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 2
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 HbAlc <8% while 36% had HbAlc >9%. 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.
PLATELET
FUNCTIONS IN PATIENTS WITH MENINGOCOCCAL MENINGITIS AT THE KENYATTA
NATIONAL HOSPITAL, NAIROBI
E.O.
Amayo, MBChB MMed (Med), Senior Lecturer, J.K Kayima, MBChB, MMed
(Med), Senior Lecturer and M.D. Joshi, MBChB MMed (Med), Lecturer,
Department of Medicine, College of Health Sciences, University of
Nairobi, P.O. Box 19676, Nairobi, Kenya.
Request for reprints to: Dr. E.O. Amayo, Department of
Medicine, College of Health Sciences, University of Nairobi, P.O. Box
19676, Nairobi, Kenya.
ABSTRACT
Objective:
To determine platelet abnormalities in patients with
menigococcal meningitis.
Design:
Case control study.
Subjects:
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.
MEDICAL
STUDENTS PERCEPTION OF PROBLEM TOPICS IN ANATOMY
B. Kramer, PhD, School of
Anatomical Sciences, University of the Witwatersrand, Johannesburg and
J.T. Soley, PhD, School of Anatomical Sciences, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, Department of
Anatomy, Faculty of Veterinary Sciences, University of Pretoria, South
Africa
Request
for reprints to: Professor B. Kramer, School of Anatomical Sciences,
Faculty of Health Sciences, University of the Witwatersrand, 7 York
Road, Parktown 2193, South Africa
ABSTRACT
Objective:
To examine the existence of perceived problem topics/concepts
in anatomy, possible reasons for the problems and also student
suggestions for alleviating the problems.
Design:
An open-ended questionnaire.
Setting:
School of Anatomical Sciences, University of the
Witwatersrand, Johannesburg, South Africa.
Subjects:
Two hundred and fifty nine second year medical students.
Main
outcome measures: The
questionnaire included identification of problem areas, reasons for
problems and possible solutions.
Results:
The survey revealed a wide range of problem topics, with the
majority being experienced in gross anatomy followed by histology and
embryology. It was clear that the students experienced difficulties
with 3-dimensional conceptualization and the visualisation of
structures.
Conclusion:
A variety of teaching aids may help in addressing this
problem and encourage spatially oriented thinking, leading ultimately
to an integrated and in-depth understanding of anatomy.
MULTIPLE DRUG RESISTANCE IN URINARY
PATHOGENS AT GONDAR COLLEGE OF MEDICAL SCIENCES HOSPITAL, ETHIOPIA
F.
Moges, BSc, MSc, Lecturer, Department of Microbiology and
Parasitology, G. Mengistu, MD, Assistant Professor, Department of
Internal Medicine and A. Genetu, BSc, Assistant Lecturer, Department
of Microbiology and Parasitology, Gondar College of Medical Sciences,
P.O. Box 196, Gondar, Ethiopia
Request for reprints to: Dr. G.
Mengistu, Department of Internal Medicine, Gondar College of Medical
Sciences, P.O. Box 196, Gondar, Ethiopia
ABSTRACT
Objective:
To determine multiple drug resistance and its associated
factors of urinary pathogens.
Design:
cross-sectional study.
Setting:
Gondar College of Medical Sciences teaching and Referral
Hospital, Northwest Ethiopia, between January and October 2000.
Subjects
and Methods: Mid
stream urine samples from 420 subjects were studied by quantitative
culture method. Designed Questionnaires were used for data collection
on the previous use of antimicrobials, catheterisation and
hospitalisation.
Main
outcome measures: Rates
of multiple drug resistance and the associated factors.
Results:
Multiple drug resistance was common in the isolates tested
against ten antibiotics showing more than 68% of the isolates being
resistant to two or more antimicrobials. Significant variables
associated with this were found to be urinary catheterisation,
hospitalisation and previous use of antibiotics for urinary tract
infection.
Conclusion:
The rate of multiple drug resistance was very high in this
study. Probable contributing factors were found to be previous
antibiotic exposure, urinary catheterization and hospitalisation.
Reduction of hospital stays and catheterisation, aseptic care of
catheterised patients and selective use of antibiotics and strict
follow up of hospital disease controls are recommended.
QUANTITATIVE ANALYSIS OF GAIT
PATTERN IN HEMIPARETIC PATIENTS
Y. Zverev, MD, PhD, A. Adeloye,
FRCS, FRCP, Department of Surgery, J. Chisi, MBChB, PhD, Department of
Anatomy, College of Medicine, University of Malawi, Private Bag 360,
Chichiri, Blantyre 3, Malawi
Request for reprints to: Dr. Y.
Zverev, Department of Physiology, College of Medicine, University of
Malawi, Private Bag 360, Chichiri, Blantyre 3,
Malawi
ABSTRACT
Objective:
To characterise gait pattern in hemiparetic patients
quantitatively using clinical footprint method.
Design:
A case control study.
Subjects:
Sixteen hemiparetic patients (12 males and 4 females) aged 16
to 64 years who attended neurological clinic at Queen Elizabeth
Central Hospital, Blantyre, Malawi.
Main
outcome measures: Stride
length, step width, foot rotation angle measured using footprint
method.
Results:
The difference in mean values of the three variables of gait
between affected and unaffected sides in hemiparetic patients was not
significant. However, strides were significantly longer in controls
than in patients (P<0.001) while patients had significantly broader
steps (P<0.02). In the controls, foot was rotated externally in
87.7% of steps and internally in 14.3% of steps. In the hemiparetic
patients, intoeing pattern was observed in 41.3 % of steps. The
difference in variability of stride length and foot angle between
affected and non-affected sides of patients was not significant.
Stride-to-stride variability in stride length in patients was 1.6
times higher than in controls. Variability of step width and foot
progression angle was 1.4 and 1.6 times higher in patients than in
controls.
Conclusion:
Footprint method provides fast and inexpensive tool for
clinical gait analysis and is suitable for evaluation of hemiparetic
patients. Our findings suggest that areas of emphasis for physical
therapy of hemiparetic patients should include increasing stride
length and decreasing step width and internal rotation of foot,
particularly on the affected side.
ROLE OF CAMPYLOBACTER
JEJUNI/COLI IN DIARRHOEA IN ILE-IFE, NIGERIA
A.O. Aboderin, BSc, MBChB, FMCPath,
Lecturer/Consultant, Department of Medical Microbiology and
Parasitology, Faculty of Basic Medical Sciences, College of Health
Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria, S.I. Smith,
BSc, MSc, PhD, Senior Research Fellow, Genetics Division, Nigerian
Institute of Medical Research, PMB 2013, Yaba, Lagos, Nigeria, A.O,
Oyelese, MD, FMCPath, Senior Lecturer/Consultant, A.O., Onipede, BSc,
MBChB, MSc, FWAP, Lecturer/Consultant, Department of Medical
Microbiology and Parasitology, Faculty of Basic Medical Sciences,
College of Health Sciences, Obafemi Awolowo University, Ile-Ife,
Nigeria, S.B. Zailani, MBBS, FMCPath, Senior Registrar, Department of
Medical Microbiology and Parasitology, Obafemi Awolowo University
Teaching Hospitals Complex, P.M.B. 5538, Ile-Ife, Nigeria and A.O.
Coker, MBBS, PhD, FMCPath, FWACP, Professor, Department of Medical
Microbiology and Parasitology, College of Medicine, University of
Lagos, PMB 12003, Lagos, Nigeria
Request for reprints to: Dr. A.O.
Aboderin, Department of Medical Microbiology and Parasitology, Faculty
of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo
University, Ile-Ife, Nigeria
ABSTRACT
Background:
Campylobacter jejuni/coli are well established causative
agents of diarrhoea. In Nigeria, gastroenteritis due to C. jejuni was
first reported in northern part of the country in 1981 and the
South-Western part in Ile-Ife in 1983.
Objective:
To re-examine the role of C. jejuni as an agent of
diarrhoea after more than a decade at Ile-Ife, Nigeria and to
determine the biological characteristics of local strains.
Design:
A prospective case control study.
Setting:
Obafemi Awolowo University Teaching Hospitals Complex
(OAUTHC) Ile-Ife, Nigeria.
Subjects:
Three hundred and three children with diarrhoea and 100
children with other medical conditions other than diarrhoea were
randomly selected.
Main
Outcome Measures: Isolation
of C. jejuni/coli from stool samples collected from the
patients and controls. Biological characteristics of the isolates.
Results:
Fifty eight (19.1%) and 6% of the patients and controls, had
the organism respectively. Campylobacter coli accounts for
53.3% of isolates. All the isolates were susceptible to erythromycin
and there was no evidence of ß-lactomase production.
Conclusion:
Campylobacter jejuni is an important diarrhoea agent in
our environment and should be considered strongly in children with
diarrhoea. Complete characterization of local, strains is necessary.
NUTRITION STATUS
OF CHILDREN IN KASESE DISTRICT AT THE UGANDA-CONGO BORDER
J.K. Tumwine, MBChB, MMed, FRSH,
Associate Professor, Department of Paediatrics and Child Health,
Makerere University Medical School and W. Barugahare, BA (SWSA),
Department of Medical Social Work, Mulago Hospital, P.O. Box 7072,
Kampala, Uganda
Request for reprints to: Prof. J.K.
Tumwine, Department of Paediatrics and Child Health, Makerere
University Medical School, P.O. Box 7072, Kampala, Uganda
ABSTRACT
Objective:
To establish the magnitude and risk factors for malnutrition
in Kasese district at the Uganda-Congo border.
Design:
Cross sectional nutrition survey.
Methods:
Thirty clusters were selected. The height, weight, and mid
upper arm circumference of at least 31 children per cluster were
measured. Data on food frequency, prevalence of cough, fever and
diarrhoea was also collected.
Results:
Half of the 932 children (49.8%) were stunted, and 21.9% were
severely stunted. While 17.4% of the children were under weight, 1.29%
were wasted and 3.7% had MUAC <12.5cm. Risk factors for stunting
included not consuming milk, fathers’ low formal education, having
no immunisation card, and not breast feeding among 12-23 months old.
Risk factors for underweight included fathers’ and mothers’ low
education level, consumption of legumes, and fever or diarrhoea two
weeks before the survey. For wasting the risk factors were consumption
of vegetables, legumes or starchy foods. Those not consuming
high-energy or animal foods including milk were likely to be severely
wasted as were those not breast feeding in the 12-23 months age group.
Fever or a diarrhoea episode two weeks preceding the survey and living
in a female-headed household, were also risk factors for severe
wasting.
Conclusion:
Attention to education, poverty alleviation, appropriate
feeding practices, prevention and treatment of infections might assist
in combating malnutrition in this district.
NOSOCOMIAL
INFECTIONS IN DEVELOPING COUNTRIES: COST EFFECTIVE CONTROL AND
PREVENTION
H. Nyamogoba, D.N., BSc, MSc.,
Assistant Lecturer and A.A. Obala, HND, MSc, Chief Technician,
Department of Medical Microbiology and Parasitology, Faculty of Health
Sciences, Moi University, P.O. Box 4606, Eldoret, Kenya
Request for reprints to: Mr. H.
Nyamogoba, Department of Medical Microbiology and Parasitology,
Faculty of Health Sciences, Moi University, P.O. Box 4606, Eldoret,
Kenya
ABSTRACT
Objectives:
To review the efficient and cost-effective preventive,
control and surveillance measures that could be employed against
nosocomial infections in developing countries.
Data
sources: Literature search on compact
disk-read only memory (CD-ROM), Medline and Internet, using the key
words: nosocomial infection, prevention and control, use of
antibiotics and use of computers. Some articles were manually
reviewed.
Study
selection: Relevant
studies or articles on nosocomial infections in developing and
developed countries were included in the review.
Data
extraction: From
individual studies or articles.
Data
synthesis: Information on nosocomial
infections from developing and developed countries with some emphasis
on Kenya is synchronized under the headings; introduction, historical
background of nosocomial infections. Current situation of nosocomial
infections and predisposing factors, nosocomial infections and
antimicrobial resistance, consequences of nosocomial infections,
hospital infection control programme and use of computers in
nosocomial infection surveillance, and the cost benefit of infection
prevention and control programme.
Conclusion:
Nosocomial infections may be contained more effectively by
having an infection prevention and control programme.
Computer-assisted epidemiological surveillance appears to be the most
important aspect of monitoring infection control programmes, and to
identify changes in risk factors that can increase the infection rate.
Even minimally, effective infection control programmes are
cost-effective. For the war against nosocomial infections to be won,
the whole exercise should be handled as a global project with
significant inputs from developing countries.
SOIL TRANSMITTED NEMATODES IN
CHILDREN IN BUEA HEALTH DISTRICT OF CAMEROON
L. Ndenecho, BSc., MSc., Graduate
Assistant, K.J.N. Ndamukong, BSc, MSc, PhD, Senior Lecturer and
Faculty Officer and M.M. Matute, BSc, MSc, PhD, Lecturer and Head of
Records Service, Faculty of Science, University of Buea, South West
Province, Cameroon
Request for reprints to: Dr K.J.N.
Ndamukong, Faculty of Science, University of Buea, South West
Province, Republic of Cameroon
ABSTRACT
Objective:
To investigate the prevalence, intensity of infection and
control of soiltransmitted nematodes in primary school pupils of
urban, suburban and rural localities.
Setting:
Buea Health District.
Design:
A cross section experimental study.
Subjects:
Three hundred and forty primary school children.
Intervention:
Mebendazole treatment complemented with health education.
Results:
The overall prevalence rate of soil-transmitted nematodes in
the Buea Health District was 59.1%. The infection rate was
significantly different in the urban, suburban and rural localities of
the health district (P<0.01), with the rural area having the
highest rate of infection. Ascaris lumbricoides was the most
predominant parasite. The intensity of infection with the various
helminth species was not significantly different between children of
urban, suburban and rural localities. Mebendazole treatment
significantly reduced the intensities of infection with Ascaris and
Trichuris (P < 0.05). The treatment, however, was
ineffective against hookworm infection. Re-infection rate with Ascaris
and Trichuris was slower in children who additionally
received health education than in those who received only
anthelminthic treatment.
Conclusion:
Ascaris lumbricoides, Trichuris trichiura and
hookworms are the predominant nematodes reported in children of urban,
suburban and rural localities in the health district. Health education
is advocated as a complement to chemotherapy in the control of
soil-transmitted nematodes.
LEVELS OF
MALONDIALDEHYDE, GLUTATHIONE AND ASCORBIC ACID IN IDIOPATHIC
THROMBOCYTOPAENIC PURPURA
G. Polat, MD., Associate Professor,
L. Tamer, PhD., Associate Professor, Department of Biochemistry, K.
Tanriverdi, M.S., E. Gürkan, MD. F. Baslamisli, MD., Professor,
Department of Haematology, and U. Atik, Professor, Department of
Biochemisty, Mersin University, Medical Faculty, Adana, Turkey
Request for reprints to: Dr. G.
Polat, Mersin Universitesi Tip Fakultesi, Arastirma Hastanesi
Biyokimya Laboratuvari, Mersin-Turkey
ABSTRACT
Background:
Idiopathic thrombocytopaenic purpura (ITP) is an autoimmune disorder,
which causes an acute or chronic thrombocytopenia, and may result in
potentially lifethreatening haemorrhage. Oxidative damage may be
involved in the pathogenesis of autoimmune diseases. Antibodies to
bind to membrane lipids and platelet destruction may play a role on
lipid peroxidation in ITP.
Objectives:
To investigate the posible role of lipid peroxidation and antioxidants
in patients with ITP.
Design:
The levels of plasma and erythrocyte malondialdehyde (MDA),
erythrocyte glutathione and ascorbic acid were analysed in patients
with ITP.
Methods.
The MDA levels were performed according to the method of Bidlack WR.
Plasma MDA, erythrocyte glutathione and ascorbic acid levels were
carried out according to the methods of Ohkawa H, Beutler E and Bauer
JD, respectively.
Results:
The erythrocyte and plasma MDA levels in patients with ITP
were found to be 9.52±4.65, 3.03±1.44 (p<0.001) and in control
group were found to be 2.49±0.57, 1.03±0.28 nmol/ml (p<0.001),
respectively. Erythrocyte glutathione was found to be 3.71±0.82, 6.26±0.66
µmol/gr Hb (p<0.001). Ascorbic acid levels of these groups were
1.09±0.25, 1.70±0.33 mg/dl (p<0.001).
Conclusion:
The oxidative damage is involved in the pathogenesis of ITP.
In patients with ITP, the platelet destruction and bleeding may play
significant role on elevation of lipid peroxidation and reduction of
antioxidant capacity. Further studies on oxidant and antioxidant
status of ITP are also needed to confirm these results.
WANDERING SPLEEN
PRESENTING AS A RIGHT HYPOCHONDRIAL MASS AND INTESTINAL OBSTRUCTION
J.W.
Githaiga, MBChB. MMed (Surg.), Department of Human Anatomy, College of
Health Sciences, University of Nairobi, P.O. Box 30197, Nairobi and
J.A. Adwok, MBBS, MMed (Surg.), FRCS(Ed), Department of Surgery,
College of Health Sciences, University of Nairobi, P.O. Box 19676
Nairobi, Kenya
Request for reprints to: Dr. J.W.
Githaiga, Department of Human Anatomy, College of Health Sciences,
University of Nairobi, P.O. Box 30197, Nairobi, Kenya
ABSTRACT
This
is a case report of a 23 year old multiparous woman who presented with
intestinal obstruction and a right hypochondrial mass. Laparatomy
revealed an infarcted 1.4Kg spleen in the right lumbar region
compressing the ascending colon. There was also ileal volvulus around
the splenic pedicle. This is probably the first documented case of
wandering spleen in the right hypochondrium, presenting as right large
bowel obstruction, to be reported in our region. Wandering spleen is a
rare condition, often asymptomatic, but may present as an acute
abdomen. Pre-operative diagnosis is difficult and rarely made.
Laboratory tests are seldom useful, but imaging studies do assist. Up
to 1971 only 350 cases had been reported in the western literature.
Review of English literature from 1900 to 1991 reported only 51 cases
in children. In our region 11 cases were reported in Uganda between
1968 and 1971. No other literature is available from our region.
Clinical presentation, aetiology, investigation, and management of
wandering spleen is discussed.
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