Nairobi Hospital

Abstract Introduction: Traveler’s diarrhea (TD) is a common condition resulting in healthcare-related travel costs and disruptions of travel plans. Objective: The objective is to assess the knowledge, attitudes, and practices (KAPs) on TD among short-term travelers to Kenya. Subjects and Methods: An airport-based cross-sectional study was conducted at Jomo Kenyatta International Airport, Nairobi City, Kenya, among 397 respondents using self-administered mobile- or paper-based questionnaires over 26 days. Participants had to be English-speaking travelers with in-country stay of >1 day but <6 months, residency outside of Africa, and aged ≥18 years. Where data was incomplete or missing, we reported the valid percentage instead. Results: Median age was 39 years, 67.9% (267/393) were below 30 years, comprising 61.5% (243/395) males, traveling from Europe (62.3%, 240/385) and the United States (12.2%, 47). Common TD-associated symptoms were stomach ache (19.1%, 76/397), diarrhea (18.9%, 75), and fatigue (12.3%, 49). Common food items implicated with TD were tap water (49.6%, 197/397), fruit salad (26.7%, 106), and fish (25.2%, 100). Only about 22.5% (88/391) of the participants believed that travel-related vaccines were inessential, while 11.3% (43/382) considered them unsafe. The majority 70.7% (280/396) sought travel health advice, mainly from the internet (47.9%, 190/397), general practitioner (28.5%, 113), or family/friends (20.9%, 83). Ninety-four percent (369/383) travelers reported high self-rating handwashing practices. Ten percent (10%, 43/396) of participants reported travel-related diseases, and 17.7% (70/395) carried self-treatment for TD. Conclusion: One in ten travelers reported illness during their trip and identified gaps in KAPs on TD that can be addressed through in-country education programs for travelers.

Findings concerning the mortality rate among inflammatory rheumatic disease (IRD) patients compared to patients without IRD indicate an increased rate amongst the former [1]. On the other hand, the difference in mortality rates appears to be somewhat negligible in countries where patients have access to modern treatments and advanced rheumatology care [2,3]. By and large, […]

PET/CT has a synergistic value for optimal diagnosis, disease activity monitoring, and evaluation of damage progression in large vessel vasculitis. The use of standardized uptake values (SUV) as a measurement of relative tissue uptake facilitates comparisons between patients, and has been suggested as a basis for diagnosis. The SUVmean and SUVmax reproducibility in vascular structures is not widely studied. The objective of this study was to evaluate the inter-observer variability of both qualitative visual grading of aortic 18F-FDG uptake and the quantitative aortic mean and maximum SUVs in these patients with mild to moderate covid-19 infection who underwent multimodality cardiac imaging within the COSMIC-19 trial. This is a sub-study of the COSMIC-19 trial. 30 patients were subjected to a combined Computed Tomography Coronary Angiogram and 18F-FDG PET/CT, followed by cardiac magnetic resonance. Two independent observers measured the Standardized uptake values in five regions of interest at each aortic segment. These were performed sequentially along the length of the aorta every 5 mm on the axial slices. The maximum and mean standard uptake values were measured. Qualitative assessment showed excellent agreement between observer x and y for the ascending aorta and aortic arch regions with the kappa coefficients for the inter observer agreement of 0.92 (95% CI:0.78-1.0) and 0.91 (95% CI:0.74-1.0) respectively. Quantitative assessment showed a very high positive correlation between the two observers for each of the regions measured for SUVmean as follows; ascending aorta r = 0.96 (p < 0.001), Aortic arch r = 0.90 (p < 0.001) and descending Aorta r = 0.91 (p < 0.001). The correlation coefficients for the SUVmax were substantially strong. This study shows an excellent inter-observer reproducibility for both qualitative and quantitative SUVmean vascular 18F-FDG measurements in patients with COVID-19 large vessel vasculitis. Quantitative SUVmax demonstrated substantially strong interobserver reproducibility.

Mortality among adults admitted to hospital with community acquired pneumonia in resource-limited settings is high. Recent studies conducted in high-income settings have demonstrated beneficial effects of low-dose corticosteroids in reducing mortality in patients with severe community acquired pneumonia. It is unknown whether these findings apply to low-income settings such as sub-Saharan Africa.This pragmatic randomized-controlled open-label trial will determine the effect of adjunctive low-dose corticosteroids in the management of adults admitted to hospital with community acquired pneumonia on mortality 30-days post-randomization. We will enroll and randomize 2180 patients admitted with a diagnosis of community acquired pneumonia into two arms: the control and intervention arm. Those in the control arm will receive standard care for the treatment of community acquired pneumonia i.e., combination therapy with a beta-lactam and macrolide antibiotic. Those in the intervention arm will receive up to 10-days treatment with low-dose oral corticosteroids in addition to standard care. All participants will be followed up to 30- days post randomization and their final status recorded (alive or dead). If adjunctive low-dose oral corticosteroids are found to be beneficial, this easily scalable intervention would significantly reduce the currently high mortality associated with community acquired pneumonia.Pan-African Clinical Trials Registry: PACTR202111481740832; ISRCTRN registry: ISRCTN36138594.

A bronchopleural fistula (BPF) is defined as an abnormal communication between an airway and the pleural space. This often can arise from complications after thoracic surgical interventions or from severe cavitating lung infections such as tuberculosis (TB). Management of BPF usually involves surgical repair through video-assisted thoracoscopy; however, this can be challenging in high-risk patients who are unsuitable for surgery. Bronchoscopic interventions are effective treatment options in patients who are unsuitable for surgery and involve the placement of valves, glues, coils, or spigots to seal the leaking bronchus. This case describes a successful BPF closure in a high-risk human immunodeficiency virus-positive patient with gastric malignancy who sustained a fistula as a result of cavitatory pulmonary TB. The procedure was done using the endobronchial Watanabe spigot, which is a cost-effective option for low-income countries. This procedure, done for the 1st time in Kenya, underscores advancements in Kenyan interventional pulmonology, offering promising outcomes in the management of BPF, in the developing interventional pulmonology sector in Kenya.

Background: Bipolar disorder is one of the most prevalent psychiatric conditions in Kenya. Studies conducted outside Kenya show that bipolar disorders and psychotic disorders are interlinked by family relations, while alcohol and substance use disorders are their important comorbidities. This study investigated the prevalence and associated factors of psychotic, alcohol and substance use disorders among first-degree relatives (FDR) of patients with bipolar disorders at a referral hospital in Western Kenya. Methods: This was a cross-sectional quantitative study. Consecutive and Simple random sampling were used, with a sample size of 381. The Mini International Neuropsychiatric Interview (MINI) was used for data collection. The chi-square test measured associations utilizing a 95% confidence interval. Results: The prevalences of psychotic, alcohol and substance use disorders were 23.6%, 13.6%, and 6%, respectively. Employment was significantly associated with psychotic disorder (P=0.038), and relation to the patient was significantly associated with alcohol use disorder (P=0.007) and substance use disorder (P=0.001). Conclusion: Among the relatives of patients with bipolar disorders, there is a high prevalence of psychotic, alcohol and substance use disorders.

Introduction: Kidney transplant is the preferred renal replacement therapy of choice over dialysis as it improves quality of life and reduces mortality. In sub-Saharan Africa, kidney transplants are rare due to a lack of resources and the cost of kidney transplants. The induction and maintenance therapies contribute to the high cost during and post-kidney transplant. We present a single-centre experience of a kidney transplant program at a private facility, M.P Shah Hospital, in Nairobi, Kenya. Methodology: This is a retrospective survey of all kidney transplants done at the M.P Shah Hospital over five years, from 2018 to 2023. Data was obtained from the files for the patients followed up at the M.P Shah Hospital and from the private nephrologists who were following up with their patients after the kidney transplant. Recipients’ and donors’ data including age, gender, blood group, HLA mismatches, date of transplant, creatinine on the day of the transplant and the creatinine on the day of discharge was obtained. The creatinine one month post-transplant and whether induction therapy was used was recorded. The proportion of patients who had HLA mismatches of more than three and those who used basiliximab was also obtained. Results: A total of 32 living kidney transplants were done from June 2018 to December 2023. 81.3% of the recipients and 69% of the donors were males. The age range of recipients was 21-72 years with the mean age being 42.25 years. 21 (67%) donors were aged between 20 and 40 years, and 11 (33%) patients were between 40 and 60 years. 18 (56.2%) patients had HLA mismatches of more than 3/6. The majority (53.13%) of the recipients were blood group O positive, while one recipient was O negative and one recipient was A negative. 65.36% of the donors were O-positive. 22 (68.7%) recipients received basiliximab as the induction agent, and no patient received anti-Thymocyte globulin or alemtuzumab. The average length of stay for the recipient was 10.7 days and the average length of stay for the donor was 3.6 days. The average serum creatinine for the recipient one-month post-kidney transplant was 123.9 micromoles per litre. The average serum creatinine for the donor on discharge was 139 micromoles per litre. 1 patient developed delayed graft function that required three dialysis sessions. The kidney biopsy showed acute cellular rejection, which responded to pulsing with methylprednisolone and recovery of graft function. Conclusion: Due to constrained resources, there are very limited kidney transplant programs in Sub-Saharan Africa. Data from our renal transplant unit shows excellent short-term outcomes without using ATG or alemtuzumab, which is recommended for high-risk transplant recipients, including those with more than 3/6 HLA mismatches. The average length of stay for the recipient and donor was also short, indicating no complications post-transplant. A more extended follow-up study is recommended to look at the long-term outcomes for these patients.

Background: Urethral prolapse is a rare cause of vaginal bleeding in prepubertal females and occursmore commonly in black girls. It is characterized by protrusion of the distal urethral mucosa at orbeyond the level of the urethral meatus. It is often mistaken for sexual abuse in children because itpresents with vaginal bleeding, creating anxiety among parents and confusion among clinicians.Case presentation: A 4-year-old girl presented to the outpatient department with a 2-day history ofvaginal bleeding. However, no lower abdominal pain was reported. Sexual abuse was initiallysuspected. A diagnosis of urethral prolapse was made during examination under anesthesia.Surgical excision and postoperative care were performed.Conclusion: Urethral prolapse, although rare, can occur in prepubertal black girls and is managedeither surgically or through conservative approaches.