Impact of varying maternal dietary folate intake on cerebellar cortex histomorphology and cell density in offspring rats.

The cerebellum has a long, protracted developmental period that spans from the embryonic to postnatal periods; as a result, it is more sensitive to intrauterine and postnatal insults like nutritional deficiencies. Folate is crucial for foetal and early postnatal brain development; however, its effects on cerebellar growth and development are unknown. The aim of this study was to examine the effects of maternal folate intake on the histomorphology and cell density of the developing cerebellum. Twelve adult female rats (rattus norvegicus) were randomly assigned to one of four premixed diet groups: standard (2 mg/kg), folate-deficient (0 mg/kg), folate-supplemented (8 mg/kg) or folate supra-supplemented (40 mg/kg). The rats started their diets 14 days before mating and consumed them throughout pregnancy and lactation. On postnatal days 1, 7, 21 and 35, five pups from each group were sacrificed, and their brains were processed for light microscopic analysis. Histomorphology and cell density of the external granule, molecular, Purkinje and internal granule layers were obtained. The folate-deficient diet group had smaller, dysmorphic cells and significantly lower densities of external granule, molecular, Purkinje and internal granule cells. Although the folate-enriched groups had greater cell densities than the controls, the folate-supplemented group had considerably higher cell densities than the supra-supplemented group. The folate supra-supplemented group had ectopic Purkinje cells in the internal granule cell layer. These findings imply that a folate-deficient diet impairs cellular growth and reduces cell density in the cerebellar cortex. On the other hand, folate supplementation increases cell densities, but there appears to be an optimal dose of supplementation since excessive folate levels may be detrimental.

Maternal usage of varying levels of dietary folate affects the postnatal development of cerebellar folia and cortical layer volumes.

OBJECTIVE: The cerebellum has a long, protracted developmental period; therefore, it is more sensitive to intrauterine and postnatal insults like nutritional deficiencies. Folate is an essential nutrient in fetal and postnatal brain development, and its supplementation during pregnancy is widely recommended. This study aimed to describe the effects of maternal folate intake on postnatal cerebellum development. METHODS: Twelve adult female Rattus norwegicus (6-8 weeks old) rats were randomly assigned to one of four groups and given one of four premixed diets: a standard diet (2 mg/kg), a folate-deficient (folate 0 mg/kg), folate-supplemented (8 mg/kg), or folate supra-supplemented (40 mg/kg). The rats began consuming their specific diets 14 days before mating and were maintained on them throughout pregnancy and lactation. Five pups from each group were sacrificed, and their brains processed for light microscopic examination on postnatal days 1, 7, 21, and 35. The data gathered included the morphology of the cerebellar folia and an estimate of the volume of the cerebellar cortical layer using the Cavalieri method. RESULTS: Folia of the folate-supplemented and supra-supplemented groups were thicker and showed extensive branching with sub-lobule formation. The folate-deficient diet group's folia were smaller, had more inter-folial spaces, or fused. When compared to the folate-deficient group, the volumes of the cerebellum and individual cerebellar cortical layers were significantly larger in the folate-supplemented and supra-supplemented groups (p<0.05). CONCLUSION: Folate supplementation during pregnancy and lactation improves the degree and complexity of the cerebellar folia and the volumes of individual cerebellar cortical layers.

Histological types of brain tumors diagnosed at the Kenyatta National Hospital between 2016 and 2019: a retrospective study.

PURPOSE: To determine the histological types of brain tumors diagnosed at the Kenyatta National Hospital, Nairobi, Kenya. METHODS: This retrospective study retrieved patient-archived records at the Kenyatta National Hospital for the period 2016-2019. The histological types of brain tumors were assessed according to age, sex, and the WHO classification for CNS tumors using the GNU PSPP version 1.6.2-g78a33 software. Results were presented in tables and figures. RESULTS: During the study period, brain tumors appeared to increase gradually; however, there was a decline in 2018. During the study period, 345 brain tumor records were retrieved. Data on age were missing 33 records; hence, 312 records were included for age analyses. The mean age for the pediatrics and adults was 9 (± 5 SD) and 45 (± 14 SD) years, respectively. 88 (28.2%) and 224 (71.8%) tumors were diagnosed among pediatrics and adults, respectively. Most tumors, 60 (19.2%) were reported in patients aged ≤ 10 years, followed by 55 (17.6%), 48 (15.4%), and 47 (15.1%) in patients aged 31-40, 51-60, and 41-50, years, respectively. In both pediatrics and adults, most tumors were diagnosed in females aged ≤ 10 years and 31-40 years, respectively. Overall, two peaks were observed in patients aged 5-15 years and 40-45 years. Gliomas, 43 (48.9%) and medulloblastomas, 21 (23.9%) were the most common tumors in pediatrics, whereas meningiomas, 107 (47.8%) and gliomas, 70 (31.3%) were the most common tumors in adults. Most pediatric and adult tumors were benign with 50 (56.8%) and 157 (70.1%) cases, respectively. Low-grade gliomas and medulloblastomas were the commonest benign and malignant tumors among pediatrics, with 31 (62%) and 21 (55.3%) cases, respectively. Conversely, meningiomas and high-grade gliomas were the most common benign and malignant tumors in adults, with 106 (67.5%) and 44 (65.7%) cases, respectively. CONCLUSION: This study highlights the existing burden of brain tumors in Kenya and data from KNH may be representative of the national burden of BTs. This study lays a foundation for subsequent clinical and epidemiological studies and emphasizes the need to adopt existing reporting standards to help realize a complete picture of the burden of brain tumors in Kenya.

Piloting a hospital-based road traffic injury surveillance system in Nairobi County, Kenya, 2018-2019.

BACKGROUND: Kenya's estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization's injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya. METHODS: We prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018-April 2019. RTI cases were defined as injuries involving ≥1 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics. RESULTS: Of the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1-89 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died. CONCLUSION: We demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.

Cerebral Artery Hypoplasia in a Select Adult Kenyan Population.

Background Hypoplasia of cerebral arteries predisposes to stroke and cerebral aneurysms which have an increased incidence in sub-Saharan Africa. The frequency and pattern of cerebral artery hypoplasia, however, shows population variations, and data from the African population remain scanty. Objectives This study aimed to determine the percentage of hypoplasia in the anterior, middle, and posterior cerebral, anterior and posterior communicating, basilar, and vertebral arteries. Materials and Methods Sections of the basilar, vertebral, posterior, and anterior communicating arteries and anterior, middle, and posterior cerebral arteries were taken, processed for histology, and examined with a light microscope at ×40. The images of the vessels were taken by a photomicroscope and circumference analyzed with the aid of Scion image analyzer. The average diameter of 10 sections was taken to be the diameter of the artery in analysis. Hypoplasia was then defined as internal diameter ≤1 mm. Photographs of representative samples of asymmetry were taken, data were analyzed using SPSS, and gender differences were analyzed using the Student's test. Results were presented in tables. Results Two hundred and eighteen formalin-fixed brains of adult Kenyans at the Department of Human Anatomy, University of Nairobi, were studied. Of the 218, 48 brains (22%) did not have vessels with any form of hypoplasia while 170 (78%) did have vessels. Of these, anterior circulation hypoplasia (anterior cerebral artery and posterior communicating artery) was seen in 100 brains (46%) and posterior circulation hypoplasia (middle and posterior cerebral, basilar, and vertebral arteries) in 69 brains (32%). Conclusion Cerebral arterial hypoplasia is frequent in the select adult Kenyan population.

Geometric features of vertebrobasilar arterial system in adult black Kenyans / Características geométricas del sistema arterial vertebrobasilar en kenianos negros adultos

Geometric features of vertebrobasilar system influence occurrence of posterior circulation atherosclerosis, aneurysms, stroke and neuroradiological procedures. These features show ethnic variation, but data from black Africans in Sub Saharan Africa are scarce. This study aimed to describe geometric features of vertebrobasilar system in a black Kenyan population. It was a descriptive cadaveric study at Department of Human Anatomy, University of Nairobi. One hundred and seventy three formalin-fixed adult brains of individuals (99 male; 74 female; Age range 20 - 79) who had died of non cerebrovascular causes were studied. Level and angle of confluence of vertebral artery; diameter, length and bifurcation angles of basilar artery were measured. Data were analysed by SPSS version 21 for windows. The student t - test was used to determine the sex differences at 95 % confidence interval. Data are presented in macrographs, tables and bar charts. Confluence of vertebral arteries occurred at the sulcus bulbopontinus in 79.8 %; rostral to it in 11.5 % and caudal to it in 8.7 % of cases. Mean angle of vertebral artery confluence was 46.7º and 68.9º in males and females respectively (p£0.042). Mean length of the basilar artery was 26.8 mm; 26.3 mm in males and 27.1 mm in females (p=0.465). Mean diameter was 3.52 mm; 3.32 mm in males and 3.72 mm in females (p=0.002). The mean angle of basilar artery bifurcation was 120.3º ± 15.2; 99.3º ± 32.9 in males and 140.3º ± 16.1 in females (p=0.024). It was wider than 90º in 82.9 % of males and 95.9 % females (p=0.032). In 85 (49.1 %) it was wider than 120º. The vertebrobasilar system in the Kenyan population has geometric features that constitute risk factors for atherosclerosis. These features display sex dimorphism which may explain differences in prevalence of atherosclerosis and aneurysms. Neurosurgeons and neurologists should be aware of these differences. Individuals with risk prone geometric features should be followed up for atherosclerosis.

Las características geométricas del sistema vertebrobasilar influyen en la aparición de aterosclerosis en la circulación posterior, aneurismas, apoplejía, detectados durante procedimientos neurorradiológicos. Estas características muestran variación étnica, pero los datos de los africanos negros en el África Subsahariana son escasos. Este estudio tuvo como objetivo describir las características geométricas del sistema vertebrobasilar en una población negra de Kenia. Fue un estudio descriptivo cadavérico en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se estudiaron 173 cerebros adultos (99 varones, 74 mujeres, rango de edad 20-79), fijados en formalina, de individuos que habían fallecido por causas no cerebrovasculares. Se midieron el nivel y ángulo de confluencia de la arteria vertebral, diámetro, longitud y bifurcación de la arteria basilar. Los datos fueron analizados por SPSS versión 21 para Windows. La prueba t de Student se utilizó para determinar las diferencias de sexo con un intervalo de confianza del 95 %. Los datos se presentan en macrografías, tablas y gráficos de barras. La confluencia de las arterias vertebrales se produjo en el surco bulbopontino en el 79,8 %; rostral al surco en 11,5 % y caudal al surco en 8,7 % de los casos. El ángulo medio de la confluencia de la arteria vertebral fue 46,70 y 68,90 en hombres y mujeres, respectivamente (p£0,042). La longitud media de la arteria basilar fue de 26,8 mm; 26,3 mm en hombres y 27,1 mm en mujeres (p=0,465). El diámetro promedio fue de 3,52 mm; 3,32 mm en hombres y 3,72 mm en mujeres (p=0,002). El ángulo medio de la bifurcación de la arteria basilar fue de 120,30 ± 15,2; 99.30 ± 32,9 en hombres y 140,30 ± 16,1en mujeres (p=0,024). Era más amplio que 90º. En un 82,9 % de los hombres y 95,9 % de las mujeres (p=0,032) se observó un ángulo más amplio que 90°. En 85 (49,1 %) fue más amplio que 120°. El sistema vertebrobasilar en la población de Kenia tiene características geométricas que constituyen factores de riesgo para la aterosclerosis. Estas características muestran dimorfismo sexual que puede explicar las diferencias en la prevalencia de aterosclerosis y aneurismas. Los neurocirujanos y los neurólogos deben tener en cuenta estas diferencias. Las personas con características geométricas propensas al riesgo deben ser seguidas por aterosclerosis.

Nonacademic Attributes Predict Medical and Nursing Student Intentions to Emigrate or to Work Rurally: An Eight-Country Survey in Asia and Africa.

AbstractWe sought to identify independent, nonacademic predictors of medical and nursing student intent to migrate abroad or from rural to urban areas after graduation in low- and middle-income countries (LMIC). This was a cross-sectional survey of 3,199 first- and final-year medical and nursing students at 16 training institutions in eight LMIC. Questionnaires assessed demographics, career intentions, and preferences regarding selected career, location, and work-related attributes. Using principal component analysis, student preferences were reduced into four discrete categories of priorities: 1) work environment resources, 2) location livability, 3) altruistic job values, and 4) individualistic job values. Students' preferences were scored in each category. Using students' characteristics and priority scores, multivariable proportional odds models were used to derive independent predictors of intentions to emigrate for work outside the country, or to work in a rural area in their native country. Students prioritizing individualistic values more often planned international careers (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.16-1.78), whereas those prioritizing altruistic values preferred rural careers (aOR = 1.82, 95% CI = 1.50-2.21). Trainees prioritizing high-resource environments preferentially planned careers abroad (aOR = 1.38, 95% CI = 1.12-1.69) and were unlikely to seek rural work (aOR = 0.60, 95% CI = 0.49-0.73). Independent of their priorities, students with prolonged prior rural residence were unlikely to plan emigration (aOR = 0.67, 95% CI = 0.50-0.90) and were more likely to plan a rural career (aOR = 1.53, 95% CI = 1.16-2.03). We conclude that use of nonacademic attributes in medical and nursing admissions processes would likely increase retention in high-need rural areas and reduce emigration "brain drain" in LMIC.

Repeated Exposure to Dissection Does Not Influence Students' Attitudes towards Human Body Donation for Anatomy Teaching.

The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this "highly informed" group of potential donors.

Effect of Monocular Deprivation on Rabbit Neural Retinal Cell Densities.

PURPOSE: To describe the effect of monocular deprivation on densities of neural retinal cells in rabbits. METHODS: Thirty rabbits, comprised of 18 subject and 12 control animals, were included and monocular deprivation was achieved through unilateral lid suturing in all subject animals. The rabbits were observed for three weeks. At the end of each week, 6 experimental and 3 control animals were euthanized, their retinas was harvested and processed for light microscopy. Photomicrographs of the retina were taken and imported into FIJI software for analysis. RESULTS: Neural retinal cell densities of deprived eyes were reduced along with increasing period of deprivation. The percentage of reductions were 60.9% (P < 0.001), 41.6% (P = 0.003), and 18.9% (P = 0.326) for ganglion, inner nuclear, and outer nuclear cells, respectively. In non-deprived eyes, cell densities in contrast were increased by 116% (P < 0.001), 52% (P < 0.001) and 59.6% (P < 0.001) in ganglion, inner nuclear, and outer nuclear cells, respectively. CONCLUSION: In this rabbit model, monocular deprivation resulted in activity-dependent changes in cell densities of the neural retina in favour of the non-deprived eye along with reduced cell densities in the deprived eye.

Variant origin of the superior cerebellar artery in a black Kenyan population

Knowledge of variant origin of the superior cerebellar artery is important during neuroradiological and neurosurgical procedures at the basilar termination and clivus regions, and may influence the occurrence of atherosclerosis and aneurysms. These variations show ethnic differences, but there are hardly any reports on the black African population. This study therefore examined the various origins of 394 superior cerebellar arteries from 173 brains of black adult Kenyans, obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya. The cranial cavity was opened and the brain removed en bloc. Arachnoid matter was gently removed to expose the arteries at the base of the brain. The distal third of the basilar artery was exposed and superior cerebellar artery identified as that which supplied the superior surface of the cerebellar hemispheres. It was traced to its origin and the source recorded. Representative patterns were photographed with a high resolution digital camera. The data were analyzed for frequency and are presented in macrographs and a table. The conventional single artery origin from the basilar artery was present in only 284 (72.1%) cases. In the remainder, it was duplicated in 84 (21.3%), originated from posterior cerebral artery in 16 (4.0%) and from common trunk with posterior cerebral artery in 10 (2.5%) cases. Variant origin of the superior cerebellar artery occurred in nearly 28% of cases studied. This influences the pattern of termination of the basilar artery, may complicate posterior cranial fossa surgery and predispose to atherosclerosis and aneurysms. Preoperative evaluation of the superior cerebellar artery is recommended

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Arterial blood supply variation in the anterior midline mandible: Significance to dental implantology.

BACKGROUND: Inter-foraminal implant placement poses a risk to the sublingual artery as it enters the mandibular midline lingual foramen. Lack of consensus on the source of this artery poses a dilemma to surgeons during management of haemorrhagic episodes. Determination of the exact source of this artery is therefore pivotal. METHODS: This was a cross-sectional descriptive study involving 34 adult human cadavers. The facial and lingual arteries were followed from the external carotid artery to determine whether they terminated as the sublingual artery. Statistical significance tests were done using the Mann-Whitney U test and Pearson product-moment correlation. RESULTS: There were 30 (88.2 %) males and 4 (11.8 %) females (male/female = 15:2) aged between 25 and 40 years. The origin of the sublingual artery was mainly from the lingual artery (73.5 %), the submental artery (17.6 %), or an anastomotic branch from the two arteries (8.9 %). The mean distance between the mandibular midline lingual foramen (MMLF) and the inferior border of the mandible was 15.58 mm (range 11.03-19.62 mm). The mean thickness of the mandible at the level of the MMLF was 10.89 mm (range 8.00-12.91 mm). No statistically significant difference was found between the two genders with regard to the morphometric measurements. CONCLUSIONS: The sublingual artery that enters the MMLF was found to be the sublingual artery as either a branch of the lingual artery (73.5 %), the submental artery (17.6 %) or an anastomosis of the lingual and submental arteries (8.9 %).

Effects of monocular deprivation on the dendritic features of retinal ganglion cells / Efectos de la privación monocular sobre las características dendríticas de las células ganglionares de la retina

Monocular deprivation results in anatomical changes in the visual cortex in favor of the non-deprived eye. Although the retina forms part of the visual pathway, there is scarcity of data on the effect of monocular deprivation on its structure. The objective of this study was to describe the effects of monocular deprivation on the retinal ganglion cell dendritic features. The study design was quasi-experimental. 30 rabbits (18 experimental, 12 controls) were examined. Monocular deprivation was achieved through unilateral lid suture in the experimental animals. The rabbits were observed for three weeks. Each week, 6 experimental and 3 control animals were euthanized, their retina harvested and processed for light microscopy. Photomicrographs of the retina were taken using a digital camera then entered into FIJI software for analysis. The number of primary branches, terminal branches and dendritic field area among the non-deprived eyes increased by 66.7%(p=0.385), 400%(p=0.002), and 88.4%(p=0.523) respectively. Non-deprived eyes had 114.3% more terminal dendrites (p=0.002) compared to controls. Among deprived eyes, all variables measured had a gradual rise in the first two weeks followed by decline with further deprivation. There were no statistically significant differences noted between the deprived and control eyes. Monocular deprivation results in increase in synaptic contacts in the non-deprived eye, with reciprocal changes occurring in the deprived eye.

La privación monocular de la visión resulta en cambios anatómicos en la corteza visual en favor del ojo no privado. Aunque la retina forma parte de la vía visual, hay escasez de datos sobre el efecto de la privación monocular en su estructura. El objetivo de esta investigación fue describir los efectos de la privación monocular en las características de las dendritas de las células ganglionares de la retina. Se diseñó un estudio cuasi-experimental. Se examinaron 30 conejos (18 experimentales, 12 controles). La privación monocular se logró a través de la sutura unilateral del párpado en los animales de experimentación. Los conejos fueron observados durante tres semanas. Cada semana, 6 animales experimentales y 3 control fueron eutanasiados, donde se obtuvo la retina y fue procesada para realizar microscopía óptica. Las microfotografías de la retina fueron tomadas con una cámara digital y luego se utilizó el software FIJI para su análisis. El número de dendritas primarias, terminales y el área del campo de dendritas en los ojos no privados aumentó un 66,7% (p=0,385), 400% (p=0,002), y 88,4% (p=0,523), respectivamente. Los ojos no privados, tenían 114,3% más dendritas terminales (p=0,002) en comparación con los controles. Entre los ojos privados, todas las variables medidas tuvieron un aumento gradual en las dos primeras semanas, seguido de descenso con mayor privación. No se observaron diferencias estadísticamente significativas entre los ojos privados y el grupo control. En conclusion, la privación monocular produce un aumento de los contactos sinápticos en los ojos no privados, con cambios recíprocos que se manifiestan en los ojos privados de la visión.

Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa.

OBJECTIVE: To assess medical and nursing students' intentions to migrate abroad or practice in rural areas. METHODS: We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students' intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. FINDINGS: Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25-2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21-6.29) and rural (OR: 4.84; 95% CI: 3.52-6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19-1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50-0.96). CONCLUSION: A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.

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 Mason's 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.

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.

Spinal tuberculosis among human immunodeficiency virus-negative patients in a Kenyan tertiary hospital: a 5-year synopsis.

BACKGROUND CONTEXT: Spinal tuberculosis (TB) accounts for more than half of all cases of skeletal TB. Although Kenya has one of the highest burdens of TB, data on spinal TB in this country remain scarce. PURPOSE: To highlight the clinical presentation and management of this condition in our setup. STUDY DESIGN: Retrospective study. SETTING: Kenyatta National Hospital in Kenya. PATIENT SAMPLE: One hundred twenty-nine patients. OUTCOME MEASURES: Patients' condition after intervention and duration of hospital stay. METHODS: This study involved review of patients admitted to our hospital between 2004 and 2009 with a diagnosis of spinal TB. RESULTS: The most common presenting complaints were back pain in 100 patients (77.5%) and limb weakness in 94 patients (72.9%), whereas the most frequent physical examination finding was gibbus deformity in 85 patients (65.8%). Most (79 patients, 61.2%) had severe motor and sensory impairment graded as either American Spinal Injury Association (ASIA) A or ASIA B. Imaging revealed multiple vertebrae disease in 90 patients (79.6%). Of these, the most common was two vertebrae disease in 77 patients (68.1%). All patients were managed using anti-TB drugs and analgesics; however, 33 (25.6%) required adjunctive operative management. Mean hospital stay was 53.3 days. Marked clinical improvement was seen in 91 patients (70.0%) within 6 months of treatment. CONCLUSION: Patients with spinal TB in our setting tended to present late and with advanced disease. Therefore, a high index of suspicion should be maintained and appropriate chemotherapy started as early as possible.

Ventriculoperitoneal shunt complications: a three-year retrospective study in a Kenyan national teaching and referral hospital.

BACKGROUND/AIMS: Ventriculoperitoneal shunt complications have scarcely been reported in sub-Saharan Africa. This study aimed at determining the frequency of these complications and their associated risk factors in a Kenyan National Teaching and Referral Hospital. METHODS: This cross-sectional study retrospectively covered 117 patients admitted to the Kenyatta National Hospital neurosurgical ward between January 2005 and December 2007 with ventriculoperitoneal shunt complications. The data obtained were analysed using the Statistical Package for the Social Sciences. RESULTS: The most common complication was obstruction in 63 patients (53.8%), followed by migration in 25 (21.4%) and infection in 23 (19.7%) of the patients. Up to 49.6% of the complications occurred in patients younger than 6 months. Multiple complications were seen in 23.9% of the cases. The mean shunt duration was 18.05 months. Positive correlations existed between the presence of a shunt complication and patient age, shunt duration and the number of complications developed. These correlations were, however, neither strong nor statistically significant. CONCLUSION: This study reports the highest frequencies of shunt obstruction and migration ever recorded in the literature. The high rate of development of multiple shunt failures coupled with a short shunt duration calls for a closer monitoring of patients with ventriculoperitoneal shunts.

Specialty preferences among medical students in a Kenyan university.

BACKGROUND: Specialty distribution in Kenya continues to exhibit gender disparities despite the increasing number of female medical students graduating each year. This study aimed at assessing specialty preferences and factors influencing these choices among male and female medical students in Kenya. METHODS: Four hundred and fifty medical students, from first to fifth year of study at the University of Nairobi, were each issued a self-administered questionnaire designed to assess their specialty preferences and factors influencing these choices. The specialty preferences were compared with the actual distribution of specialists in Kenya. Data collected were analyzed using Statistical Package for Social Sciences. RESULTS: Three hundred and eighty five (85.6%) questionnaires were completed. Surgery had the highest preference rate followed by pediatrics, internal medicine and obstetrics and gynecology. Significantly more males preferred surgery than females who mainly selected pediatrics (p<0.001). There was an increased likelihood of female students choosing controllable lifestyle specialties. These preferences mirrored the actual distribution of specialists in Kenya. Male students significantly considered prestige in a specialty (p=0.006), while their female counterparts mostly considered ease of raising a family and gender distribution in the specialty (p<0.001). CONCLUSION: Gender-based similarities and differences exist in factors influencing specialty preferences among Kenyan medical students. These factors may explain the observed specialist doctor distribution in the country.