LITHOPAEDON PRESENTING AS INTESTINAL OBSTRUCTION WITH A PREVIOUS CO-EXISTING INTRA-UTERINE PREGNANCY.

This is a case report of a 25 year old lady Para 4 + 0 gravida 5, who was referred to Kisii level 5 hospital from a district hospital with a diagnosis of intestinal obstruction and a four year history of an intra-abdominal mass. A year prior to the admission she conceived and delivered vaginally at home but the baby died a few hours after the delivery. On examination on admission there was a solid mass in the right upper quadrant. Ultrasound imaging showed a poor echo-calcified mass suggestive of a colonic metastatic mass and an erect abdominal x ray revealed foetal bones within the abdominal cavity. At laparatomy a lithopedion with a normal uterus was found. The presence of a lithopedion and a normal intra-uterine pregnancy followed by spontaneous vertex delivery has not been reported in Kenya. Patients with lithopaedon can present with intestinal obstruction as a complication but the presence of a co-existing pregnancy is rare.

Identification of frequently recognized dimorphic T-cell epitopes in plasmodium falciparum merozoite surface protein-1 in West and East Africans: lack of correlation of immune recognition and allelic prevalence.

The merozoite surface protein-1 (MSP1) is the most studied malaria blood-stage vaccine candidate. Lymphokines such as interferon gamma (IFN-gamma) and interleukin 4 (IL-4) may mediate blood-stage specific protection. Here we identify Plasmodiumfalciparum MSP1 T-cell epitopes capable of rapid induction of IFN-gamma and/or IL-4 from peripheral blood mononuclear cells of East and West African donors. Both allelic forms of these novel MSP1 T-cell epitopes were stimulatory. An unusually high numbers of Gambian responders (> 80%) to these epitopes were observed, suggesting that MSPI reactivity may have been underestimated previously in this population. Surprisingly, IFN-gamma responses to allelic T-cell epitopes failed to correlate with differential antigenic exposure in The Gambia compared to Kenya. These results suggest an unexpected level of immunoregulation of IFN-gamma response with variable allelic T-cell reactivity independent of the level of antigenic exposure. Further analysis of the mechanisms determining this response pattern may be required if vaccines are to overcome this allelic reactivity bias in malaria-exposed populations.

Survey of knowledge, behaviour and attitudes relating to HIV infection and AIDS among Kenyan secondary school students.

To evaluate the knowledge, attitudes and sexual behaviour with respect to HIV and AIDS among Kenyan secondary school students, a questionnaire was issued to 3,018 students of mean age 16.3 years in 11 Kenyan schools. Questions of knowledge were answered correctly by an average of 77.1% of students. Areas where students' knowledge was less complete included the inability of mosquitoes to transmit the virus, the protective effect of condoms, the lack of protection from medications, the fatal and incurable nature of AIDS, and the fact that those infected with HIV may appear healthy. No prior sexual experience was reported by 71.3% of females and 25.2% of males. Multiple sexual partners were reported by 41.2% of males and 7.3% of females. Sixty per cent of students denied ever using condoms during sex and only 6.8% of those with multiple partners used them all the time. A prior sexually-transmitted disease was reported by 5.6% of students. Although a high level of knowledge regarding HIV and AIDS is evident among Kenyan students there is a sizable number who admit to extensive sexual experience, but who are not using condoms, thereby putting themselves at risk.

Feighner's symptom profile of alcoholism in a Kenyan general hospital.

Eighty-three consecutive first-ever admissions to the general medical wards at the Kenyatta National Hospital ( KNH ), were screened for alcoholism using the Feighner's Research Diagnostic Criteria for Alcoholism ( FRDCA ) in their first week of admission. They were aged between 18-65 years and able to give informed consent and participate in an interview. 48% of the males, 13% of the females and 31% of the overall sample scored for definite alcoholism. Abnormal drinking behaviour and social pathology associated with drinking rather than the medical and psychiatric aspects of alcoholism were more associated with the alcoholism group. These findings are compared and contrasted with similar findings in Western settings.