H Saidi

Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry ligament in Kenyans.

Injury to the recurrent laryngeal nerve (RLN) is an important but avoidable complication of thyroidectomy. This complication may be avoided by the identification of the nerve facilitated by important landmarks found along its course. The setting for this work is the Human Anatomy Laboratory of the University of Nairobi. The aim of this work is to determine the topographic relationship of the RLN with the inferior thyroid artery (ITA), the tubercle of Zuckerkandl (TZ), and the ligament of Berry (LB) in a Kenyan population. The relationship between the nerve and the above landmarks was determined during dissection of 146 right and left thyroid lobes. One right side of the neck had a nonrecurrent nerve. Of the specimens where relationship was determined, the nerve was anterior to the ITA in 37% of cases and posterior in 51.4%. In relation to the LB, 45.3% were superficial (dorsolateral). The TZ was clearly delineated in 86 of the 146 specimens. No nerve traversed the tubercle. The RLN exhibited variations similar to those in other populations. The TZ when present was a reliable landmark to the nerve. Clin. Anat. 24:853–857, 2011.

Establishing hospital-based trauma registry systems: lessons from Kenya

OBJECTIVE In the developing world, data about the burden of injury, injury outcomes, and complications of care are limited. Hospital-based trauma registries are a data source that can help define this burden. Under the trauma care component of the Bloomberg Global Road Safety Partnership, trauma registries have been implemented at three sites in Kenya. We describe the challenges and lessons learned from this effort. METHODS A paper-based trauma surveillance form was developed, in collaboration with local hospital partners, to collect data on all trauma patients presenting for care. The form includes demographic information, pre-hospital care given, and patient care and clinical information necessary to calculate estimated injury surveillance. The type of data collected was standardized across all three sites. Frequent reviews of the data collection process, quality, and completeness, in addition to regular meetings and conference calls, have allowed us to optimize the process to improve efficiency and make corrective actions where required. RESULTS Trauma registries have been implemented in three hospitals in Kenya, with potential for expansion to other hospitals and facilities caring for injured patients. The process of establishing registries was associated with both general and site-specific challenges. Problems were identified in planning, data collection, entry processes, and analysis. Problems were addressed when identified, resulting in improved data quality. CONCLUSIONS Trauma registries are a key data source for defining the burden of injury and developing quality improvement processes. Trauma registries were implemented at three sites in Kenya. Problems and challenges in data collection were identified and corrected. Through the registry data, gaps in care were identified and systemic changes made to improve the care of the injured.

Outcome For Hospitalized Road Trauma Patients at a Tertiary Hospital in Kenya

Background:The developing world continues to experience a disproportionate burden of injury. About one half of injury deaths are due to motor vehicle collisions. Road traffic fatalities per 10,000 vehicles are ten to 20 times higher in Africa compared to Europe.Patients and Methods:233 patients were consecutively analyzed. Injury acuity was determined by calculating Injury Severity Scores (ISS) for each patient. Information on the care and treatment outcome was obtained from patient interviews, case notes and discharge summaries. Data analysis was performed using the SPSS version 10.0 statistical software.Results:Injury accounted for 48.8% of all emergency hospitalizations into the surgical units. Injury due to traffic comprised a third (31%) of trauma admissions. Injuries to the limbs were predominant (54%). Acuity ranged from ISS 1 to 43. The mean ISS was 8.78. Major injury (ISS > 15) constituted 13% of all the admissions. Operating room resources were utilized in 52% of the patients (major operations were performed in 12% of this group). The overall complication rate was 12.0%. Although the overall mortality amounted to 6%, mortality was 35.6% amongst those with major injury. It was also higher with associated head injury, pedestrian injury and weekend injury.Conclusion:The overall trauma acuity was moderate injury. Mortality escalated to 35% for major injury. There is need to explore the factors contributing to this high mortality and a system of care that can optimize outcome.

Locating the Arcuate Line of Douglas: Is It of Surgical Relevance?

Ventral hernia formation is a common complication of rectus abdominis musculocutaneous flap harvest. The site and extent of harvest of the flap are known contributing factors. Therefore, an accurate location of the arcuate line of Douglas, which marks the lower extent of the posterior wall of the rectus sheath, may be relevant before harvesting the flap. This study is aimed at determining the position of the arcuate line in relation to anatomical landmarks of the anterior abdominal wall. Arcuate lines were examined in 80 (44 male, 36 female) subjects, aged between 18 and 70 years, during autopsies and dissection. The position of the arcuate line was determined in relation to the umbilicus, pubic symphysis, and intersections of rectus abdominis muscle. Sixty four (80.4%) cases had the arcuate line. In most cases (52), this line was located in the upper half of a line between the umbilicus and the pubic symphysis. Most males (93%) had the arcuate line, while more than a third of females did not have it. In all these cases, the line occurred bilaterally as a single arcade, constantly at the most distal intersection of the rectus abdominis muscle. Consequently, the arcuate line is most reliably marked superficially by the distal tendinous intersection of the rectus abdominis muscle. Harvesting of the muscle cranial to this point will minimize defects in the anterior abdominal wall that may lead to hernia formation. Clin. Anat. 23:84–86, 2010.

Child maltreatment at a violence recovery centre in Kenya

SUMMARY Kenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Womens Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were ≤5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.

Unusual formation of the median nerve associated with the third head of biceps brachii

We read with interest the recent paper by Ongeti et al. (2012). The authors reported the presence of a third head of biceps brachii in dissected upper limb of male cadaver and concluded that this supernumerary head of biceps muscle may compress the proximal median nerve. However, it seems hard to accept that the muscle shown in the figure of this article is biceps brachii. The normal two heads of biceps muscle are not dissected and still covered by deep fascia. In addition, the distal attachment of the claimed third head of biceps as well as its nerve supply is not shown. As this third head of biceps is medial in position, it will be important to show a dissection of the coracobrachialis muscle which is attached to the medially located short head of biceps. Moreover, the musculocutaneous nerve supplying the biceps muscle is not shown. What is (8) in the figure legend? No indication for (8) in the figure. Entrapment or compressive neuropathies are widespread clinical problems caused by compression of a nerve such as median nerve when it passes through fibro-osseous or muscular tunnels as Gantzer’s muscle or deep to aponeurotic and vascular channels (Eid and Otsuki, 2009; Eid et al.,2011). We would like to mention that Clinical Anatomy is one of the leading journals in gross and clinical anatomy; therefore, the quality of dissection as well as photographing a carefully dissected specimen is extremely important for anatomists and medical doctors.

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

Epidemiology and outcomes of injuries in Kenya: A multisite surveillance study

Background. Injury is a leading cause of disability and death worldwide, accounting for over 5 million deaths each year. The injury burden is higher in low‐ and middle‐income countries where more than 90% of injury‐related deaths occur. Despite this burden, the use of prospective trauma registries to describe injury epidemiology and outcomes is limited in low‐ and middle‐income countries. Kenya lacks robust data to describe injury epidemiology and care. The objective of this study was to investigate the epidemiology and outcomes of injuries at 4 referral hospitals in Kenya using hospital‐based trauma registries. Methods. From January 2014 to May 2015, all injured patients presenting to the casualty departments of Kenyatta National, Thika Level 5, Machakos Level 5, and Meru Level 5 Hospitals were enrolled prospectively. Data collected included demographic characteristics, type of prehospital care received, prehospital time, injury pattern, and outcomes. Results. A total of 14,237 patients were enrolled in our study. Patients were predominantly male (76.1%) and young (mean age 28 years). The most common mechanisms of injury were road traffic injuries (36.8%), falls (26.4%), and being struck/hit by a person or object (20.1%). Burn was the most common mechanism of injury in the age category under 5 years. Body regions commonly injured were lower extremity (35.1%), upper extremity (33.4%), and head (26.0%). The overall mortality rate was 2.4%. Significant predictors of mortality from multivariate analysis were Glasgow Coma Scale ≤12, estimated injury severity score ≥9, burns, and gunshot injuries. Conclusion. Hospital‐based trauma registries can be important sources of data to study the epidemiology of injuries in low‐ and middle‐income countries. Data from such trauma registries can highlight key needs and be used to design public health interventions and quality‐of‐care improvement programs.

Variant anatomy of the uterine artery in a Kenyan population

To investigate the uterine arterys origin, branching patterns, and relation to the ureter in a Kenyan population.

Understanding patterns of injury in Kenya: analysis of a trauma registry data from a National Referral hospital.

Background. Injuries contribute to a substantial proportion of the burden of disease in Kenya. Trauma registries can be a very useful source of data to understand patterns of injuries and serve to provide information about potential improvements in the care of injured patients. In Kenya, health facility‐based injury data has been largely administrative. Our aim was to develop and implement a prospective trauma registry at the largest trauma hospital in Kenya, the Kenyatta National Hospital, and to understand the nature of injuries presenting to the hospital, their treatment and care, and their outcomes. Methods. An electronic, tablet‐based instrument was developed and implemented between January 2014 and June 2015. Data were collected at the emergency department, and patients were followed through disposition from the emergency department or in‐patient wards if admitted. Variables included demographics, type of prehospital care received, details of the injury, and initial assessment and disposition from the emergency department or in‐patient wards. Bivariate and multiple logistic regressions were used to assess potential risk factors associated with outcomes. Results. A total of 8,701 injury patients were included in the registry during the study period. The mean age of the injured patients was 28 years (standard deviation, 26 years). The majority of these patients were males (81.7%). The leading mechanisms of injuries were road traffic injury (41.7%), assault (25.3%), and falls (18.9%). Only 7.4% of patients received prehospital care; 49.6% of injured patients arrived within 1 hour after their injury. Hospital mortality was 4.4% and close to 1% of patients died in the emergency department. The independent predictors of in‐hospital death were older age (≥60 years), injury mechanism (burns and road traffic injuries), and admission type (transfer) after controlling for injury severity. Conclusion. The establishment of hospital‐based trauma registries can be an important tool for injury surveillance. This information will facilitate identifying priority areas for trauma care and quality improvement, as well as guiding the development of injury prevention and control programs.