Simeon R Sinkeet

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.

Variations in branching of the posterior cord of brachial plexus in a Kenyan population

Background Variations in the branching of posterior cord are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the African population is scarce. Objective To describe the branching pattern of the posterior cord in a Kenyan population. Materials and methods Seventy-five brachial plexuses from 68 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of the posterior cord was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels). Results Only 8 out of 75 (10.7%) posterior cords showed the classical branching pattern. Forty three (57.3%) lower subscapular, 8(10.3%) thoracodorsal and 8(10.3%) upper subscapular nerves came from the axillary nerve instead of directly from posterior cord. A new finding was that in 4(5.3%) and in 3(4%) the medial cutaneous nerves of the arm and forearm respectively originated from the posterior cord in contrast to their usual origin from the medial cord. Conclusions Majority of posterior cords in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury. A wider study of the branching pattern of infraclavicular brachial plexus is recommended.

Intracranial aneurysms in an African country.

BACKGROUND Characteristics of intracranial aneurysms display ethnic variations. Data on this disease from the African continent is scarce and often conflicting. AIM To describe site, age and gender distribution of intracranial aneurysms among Kenyans. STUDY DESIGN AND SETTING Retrospective study at Kenyatta National Hospital, Kenya. MATERIALS AND METHODS All records of black African patients with a diagnosis of intracranial aneurysms seen at Kenyatta National Hospital, the largest referral hospital in the Eastern and Central African region, over the period from January 1998 to December 2007 were examined for site, age and gender distribution. The data gathered were coded, analyzed with SPSS 11.50. RESULTS Fifty-six cases of intracranial aneurysms were analyzed. The posterior communicating artery was the most affected (35.7%), followed by the anterior communicating artery (26.8%), while the posterior cerebral artery was the least affected (2%). Multiple aneurysms were present in 2%. The mean age at presentation was 50.9 years (range 21-80 years) and the gender distribution was equal. CONCLUSIONS Intracranial aneurysms among Kenyans occur most commonly on the posterior communicating artery, in young individuals, and without gender bias. The distribution differs from that described in the literature and this requires search for risk factors.

Variations in the position and length of the vermiform appendix in a black kenyan population.

Background. Topography of the appendix influences its mobility, degree of mobilization of the cecum, and need for additional muscle splitting during appendectomy. Although appendectomy is a common surgical procedure, there is a paucity of data on its topography in black Africans. Methods. The position and length of the appendix and relation of the appendicular base with spinoumbilical line were determined in 48 cadavers obtained from the Department of Human Anatomy, University of Nairobi, Kenya. Results. The commonest appendicular types in males were retrocecal 10 (27%) while in females was subileal 4 (36.4%). The average length of the appendix was 76.5 ± 23.6 mm. The base of the appendix was located along, below, and above the spinoumbilical line in 25 (52.1%), 9 (18.8%), and 14 (29.2%) cases, respectively. Conclusion. The topography of appendix in Kenyans shows variations from other populations. Knowledge of these variations is important during appendicectomy.

Branching Pattern of Inferior Mesenteric Artery in a Black African Population: A Dissection Study

Background. Branching pattern of inferior mesenteric artery (IMA) and pattern of vascular supply to the left colon and rectosigmoid areas, though important during colorectal surgery, display interethnic variations. Further, these regions have notable vascular “weak points” reported to be highly susceptible to ischemic colitis. This study aimed at evaluating the branching pattern of IMA in a black African population. Materials and Methods. Fifty-seven formalin-embalmed cadavers (28 Male, 27 Female) were studied. The length, branching pattern, and diameter of IMA at its origin were recorded. Results. IMA mean length and diameter at origin were 30.57 ± 10.0 mm and 4.10 ± 0.9 mm, respectively. IMA most frequently branched into left colic artery and a common sigmoid trunk in 23 cases while the classical branching pattern was observed in only 7 cases. Colic marginal artery was absent at the splenic flexure and sigmoid colon in 7 and 5 cases, respectively. Arc of Riolan was observed in 9 cases. Conclusion. Branching pattern of IMA shows variations from the previously reported cases which might help account for some of the untoward outcomes observed following colon surgery. An angiographic study to further delineate functionality of the arterial anastomoses in this region is recommended.

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.