Beda Olabu

Pattern of congestive heart failure in a Kenyan paediatric population

Background Heart failure in children is a common cause of morbidity and mortality, with high socio-economic burden. Its pattern varies between countries but reports from Africa are few. The data are important to inform management and prevention strategies. Objective To describe the pattern of congestive heart failure in a Kenyan paediatric population. Methods This was a retrospective study done at Kenyatta National Hospital, Nairobi Kenya. Records of patients aged 12 years and younger admitted with a diagnosis of heart failure between January 2006 and December 2010 were examined for mode of diagnosis, age, gender, cause, treatment and outcome. Data were analysed using the Statistical Programme for Social Scientists version 16.0 for windows, and presented in tables, bar and pie charts. Results One hundred and fifty-eight cases (91 male, 67 female) patients’ records were analysed. The mean age was 4.7 years, with a peak at 1–3 years. The male:female ratio was 1.4:1. All the cases were in New York Heart Association (NYHA) class II–IV. Evaluation of infants was based on the classification proposed by Ross et al. (1992). Diagnosis was made based on symptoms and signs combined with echocardiography (echo) and electrocardiography (ECG) (38%); echo alone (12.7%); ECG, echo and chest X-ray (CXR) (11.4%); and ECG alone (10.8%). The underlying cause was established on the basis of symptoms, signs, blood tests, CXR, echo and ECG results. Common causes were infection (22.8%), anaemia (17.1%), rheumatic heart disease (14.6%), congenital heart disease (13.3%), cardiomyopathy (7.6%), tuberculosis and human immunodeficiency virus (6.9% each); 77.9% of patients recovered, 13.9% after successful surgery, and 7.6% died. Conclusion Congestive heart failure is not uncommon in the Kenyan paediatric population. It occurs mainly before five years of age, and affects boys more than girls. The majority are due to infection, anaemia, and rheumatic and congenital heart diseases. This differs from those in developed countries, where congenital heart disease and cardiomyopathy predominate. The majority of children usually recover. Prudent control of infection and correction of anaemia are recommended.

Pediatric stroke in an African country

Background: The pattern of pediatric stroke displays ethnic and geographical variations. There are few reports from black Sub-Saharan Africa, although relevant data are important in prevention, clinical diagnosis, treatment and prognostication. Aim: To describe subtypes, risk factors, localization, age and gender distribution of pediatric stroke in the black Kenyan population. Study Design and Setting: Retrospective cross-sectional study in a single regional referral and teaching hospital. Statistical Analysis: Data were analyzed by SPSS version 13.0 for Windows and presented in tables and bar and pie charts. Materials and Methods: The study was performed at the Kenyatta National Hospital, a level-6 regional referral health facility with an annual pediatric in-patient turnover of about 40,000 patients. Files of patients aged 1 month to 18 years over a period of 5 years were analyzed for stroke subtypes, localization, risk factors, age and sex distribution. Only those files with complete information were included. Results: Thirty-two of the 712 stroke patients (4.5%) were pediatric. The male:female ratio was 1.7:1. Ischemic stroke comprised 56.3% (n = 18). Mean age was 7.7 years (range, 1.5–18 years). The most common sites were cortical (51%), lacunar (41%) and brain stem (8%). The most common risk factors were connective tissue disorders (28.1%), heart disease (25%), human immunodeficiency virus (9.4%) and infection (9.4%). Conclusion: Pediatric stroke is not uncommon in the Kenyan population. The risk factor profile comprising connective tissue disorders and infection differs from that reported in other populations, inviting large community-based studies.

Pattern of acute myocardial infarction in an African country

OBJECTIVE The objective of this study was to describe the pattern of acute myocardial infarction in an African country. These data are important for prevention strategies but are scarce from sub-Saharan African countries and altogether absent from Kenya. METHODS AND RESULTS This was a retrospective study done at Kenyatta National Hospital, Kenya. Cases of acute myocardial infarction admitted to the hospital between January 2000 and December 2009 were examined for mode of diagnosis, age, gender, risk factors, and outcome. Only those with confirmed diagnosis were included. Results were analysed by SPSS version 13.0 for Windows, and are presented in tables and bar charts. One hundred twenty cases (80 men; 40 women) were analysed. Clinical diagnosis had been confirmed by electrocardiography and cardiac enzymes (87.5%), angiography (8.3%) and echocardiography (4.2%). Mean age was 56.8 years and male:female ratio 2:1. Common risk factors were hypertension (35%), diabetes mellitus (20.8%), smoking and infection 12.5% each and alcohol (10.8%). The majority (50.8%) of the patients recovered, 44.2% developed congestive cardiac failure and only 5% died. CONCLUSION Acute myocardial infarction is not uncommon in Kenya. Over 30% of the patients are 50 years and younger and it carries a high morbidity from heart failure. Risk factors comprise a combination of non-communicable diseases, namely hypertension and diabetes mellitus, coexisting with infections. Control measures targeting both categories are recommended.

Pattern of hypertensive kidney disease in a black Kenyan population.

Background: Hypertensive kidney disease is a major cause of morbidity and mortality. Its pattern displays geographical and ethnic variations. Data on these patterns are important for informing management and prevention strategies, but on Kenyans such data are scarce. Objective: By means of a retrospective study at Kenyatta National Hospital, Nairobi, we aimed to describe the pattern of hypertensive kidney disease in a black Kenyan population. Methods: Records of hypertensive patients who had impaired kidney function between January 2000 and December 2010 were examined for mode of diagnosis, age, gender, comorbid factors, treatment and outcome. Data were analyzed using the Statistical Package for Social Sciences, version 16.0 for Windows, and are presented using tables and bar charts. Results: A total of 114 cases (72 males, 42 females) were analyzed. The mean age was 42.7 years (range 12–83), peaking at 51–70 years. The male to female ratio was 1.7:1. Comorbid factors included left ventricular hypertrophy (21.1%), congestive heart failure (15.8%), alcohol (11.4%), cerebrovascular accidents, smoking and retinopathy (10.5% each). Multiple comorbid factors were present in 8.8% of the cases. The majority (52.6%) of the patients survived on hemodialysis, 8.8% underwent successful renal transplant and 22.8% died. Conclusion: Hypertensive kidney disease affects all age groups, males more than females. It is commonly associated with other cardiovascular conditions and carries a high morbidity. Vigilant control of blood pressure is recommended.

Pattern of aortic aneurysms in an African country

OBJECTIVE We sought to describe the regional, age, and sex distribution; diagnosis; treatment; and outcome of aortic aneurysms in a Kenyan population. METHODS This was a retrospective study at Kenyatta National Hospital, Kenya. Records of black African patients whose final diagnosis was aortic aneurysm over the period from January 1998 to December 2007 were examined. Frequencies and means are presented in tables and bar charts. RESULTS Two hundred sixty-four (92 male and 172 female patients) files were analyzed. The mean age was 56.15 years. Two hundred twenty-three (84.5%) aneurysms occurred in the abdominal aorta, followed by the descending aorta (7.5%), ascending aorta, (3.8%) and arch (1.9%). In 2.3% of cases, both the abdominal and thoracic aortas were affected. The male/female ratio was 1:1.9. Pain with swelling or a pulsatile mass was the predominant feature. More than 50% of the cases were diagnosed by means of ultrasonographic analysis. Sixty-one (23.1%) aneurysms were ruptured, and of this group, 44 (72.1%) patients died. Successful open surgical repair was done in 157 (59.5%) patients. Hypertension was a comorbidity in 137 (51.9%) cases. CONCLUSIONS Aortic aneurysms in Kenya show abdominal segment and female predominance, occur 10 to 15 years earlier than in white populations, and carry high mortality from rupture. Hypertension was the leading associated risk factor. Ultrasonographic screening and control of blood pressure might be useful preventive measures.

Prevalence and distribution of the third coronary artery in kenyans

La tercera arteria coronaria (TCA) ha sido definida como una rama directa del seno aortico derecho (RAS) y contribuye a la vascularizacion del cono arterioso del ventriculo derecho (RV). La distribucion de esta arteria puede ser importante en los procedimientos quirurgicos y para comprender la magnitud y progresion del infarto agudo del miocardio. El reporte de su prevalencia, sin embargo, muestra disparidad etnica. Se describen la prevalencia y distribucion de la tercera arteria coronaria en la poblacion keniana, en un estudio transversal. Se utilizaron 148 corazones de cadaveres adultos, obtenidos del Departamento de Anatomia de la Universidad de Nairobi y de las morgues, de las ciudades de Chiromo y Nairobi, luego de su aprobacion etica. Se estudiaron en los corazones por medio de la diseccion macroscopica, la anatomia topografica de la TCA y su prevalencia. Los datos fueron codificados y analizados utilizando el software SPSS. La TCA estuvo presente en el 35,1% de los corazones. Su distribucion variable fue del 23% en el sistema de conduccion cardiaco, un 100% en la pared anterior del ventriculo derecho, 51,9% en el septo interventricular (IVS) y en el apex del corazon un 5,8%. La tercera arteria coronaria contribuye sustancialmente a la vascularizacion cardiaca y puede estar presente en cerca de un tercio de los kenianos. Esto puede constituir una significativa circulacion colateral para la perfusiones apical y septal. En la interpretacion de signos y sintomas de oclusion coronaria se puede considerar la posible contribucion de este vaso

Cortical stroke in Kenya

(3). We conducted a 5-year survey study of 4733 Egyptians using extracranial duplex, in Cairo University Hospitals. Atherosclerotic carotid disease was detected in 41% of the studied population, of which 17 6% in the form of intimal thickening, and 23 4% in the form of variable degrees of stenosis. Significant and clinically relevant stenosis (Z50%) was found in only 2 5% of atherosclerotic cases (Fig. 1). This percentage of significant atherosclerotic carotid disease found in Egyptians is much lower than that estimated in studies conducted in developed countries (4, 5), despite the fact that risk factors are more or less the same. This raises a number of questions regarding the cause of this discrepancy. Are there any underlying unknown factors, whether nutritional, genetic, environmental or life style? Is the rate of intracranial atherosclerosis higher than extracranial disease? The true answer is still obscure, and only more studies and surveys, with the additional efforts undertaken by health authorities, can help elucidating and clearing this issue.

Pattern of acquired neck masses in a Kenyan paediatric population

Acquired paediatric neck masses constitute a diagnostic challenge. Their pattern is important in formulating management protocol. Reports from developing countries including Kenya are scarce. This study describes the causes, location, clinical features and gender distribution of these masses in a Kenyan paediatric population. This prospective cross-sectional study was carried out in a regional Eastern and Central African referral centre in Kenya. Children aged 16 years and below with neck masses, who presented to various clinics and wards in a 5 month period were examined. One hundred and eighty four of 235 masses (78%) were acquired. Inflammatory cases were the most common (64%), followed by malignant neoplasm (32%). The most common inflammatory cases were abscesses, reactive lymphadenopathy and tuberculous adenitis. They mainly involved upper cervical and submandibular lymph nodes and were more prevalent in those aged less than 4 years. Lymphomas were the most common malignant masses (42%). Malignant masses were widespread in location; non-tender, and most frequent in those aged 4-8 years. In conclusion, inflammatory conditions consistent with upper airway infection cause most acquired paediatric neck masses, but malignant neoplasms constitute a significant proportion. Prudent management of infection and early confirmation of diagnosis are recommended.

Features of atherosclerosis in the tunica adventitia of coronary and carotid arteries in a black kenyan population.

Introduction. Histologic changes which occur in the tunica adventitia during initiation, progression, and complications of atherosclerosis are seldom reported. This study aimed at describing the features of atherosclerosis in the tunica adventitia of two of the commonly afflicted arteries, namely, left anterior descending coronary and common carotid in black Kenyans. Materials and Methods. Specimens from 108 individuals [76 males and 32 females, mean age 34.6] were processed for paraffin embedding. Seven micron thick sections were stained with Masons trichrome and Haematoxylin/Eosin and examined with a light microscope. Results. Features of atherosclerosis were present in the tunica adventitia of 14.8% of left anterior descending arteries and 11.1% of common carotid arteries. Increase in adventitial thickness was associated with increased density of vasa vasora in 8.3% of both arteries. In the left anterior descending and common carotid arteries, 6.5% and 3.7% of cases, respectively, the tunica adventitia thickened without intimal hyperplasia. Conclusion. Features of atherosclerosis occur in the tunica adventitia of coronary and carotid arteries in over 10% of the black Kenyans studied. These features often precede the intimo medial changes. Tunica adventitia should therefore be prioritized in evaluation for atherosclerosis, in individuals at risk. This may enhance early detection and intervention.

Ischemic Cortical Stroke in a Kenyan Referral Hospital

Background: The pattern of stroke displays ethnic and geographical variations. In Sub-Saharan Africa there is scarcity of data from Eastern and Central Africa. Objective: To describe the characteristics of patients with ischemic cortical stroke in a Kenyan referral hospital. Study design and set up: Retrospective study at Kenyatta National Hospital, Nairobi Kenya. Patients and methods: Records of adult black Kenyan patients seen with ischemic cortical stroke at Kenyatta National Hospital, Nairobi, Kenya between January 2007 and December 2011 were examined for age, sex, site, comorbidities and outcome. Only files with complete data were included. Data were analyzed by SPSS version 17.0 for Windows and presented in tables and bar charts. Results: Three hundred and seven cases of ischemic cortical stroke were analyzed. Mean age was 54.7 years, with 20.6% of cases occurring below 40 years. The male: female ratio was 1:1.2 with female predominance in all age groups. Brain regions most commonly affected were fronto-parietal (32.8%) and parietal (31.6%), while 11.6% involved extensive regions of the cerebral cortex. Predominant single comorbidities were hypertension (64.1%), smoking (19.2%), alcohol (13.4%), HIV infection (6.8%) and bacterial infections (6.8%). Multiple risk factors were implicated in 42.4% cases. Two hundred (65.1%) suffered paralysis; 70 (22.8%) clinically recovered and 37 (12.1%) died within 90 days. Conclusion: Ischemic cortical stroke occurs in young individuals in over 20% of the study population and is female predominant. Hypertension, cigarette smoking and infections including HIV are the leading comorbidities, and it causes high morbidity. Control measures comprising regulation of blood pressure, reduction of smoking and prudent management of infections should be instituted from early in life.