Fresh vs. frozen embryo transfers in patients with KIR Bx haplotype: impact on reproductive outcomes.

OBJECTIVE: A controversy persists over whether or not the type of embryo transfer (ET) influences reproductive outcomes. This study aimed to evaluate the reproductive outcomes of pregnant patients undergoing their first in vitro fertilization procedure and explore the influence of various KIR genotypes on these reproductive outcomes. PATIENTS AND METHODS: Prospective enrollment of patients with infertility who sought treatment at Origyn Fertility Center in Iasi, Romania, was conducted between January 2019 and March 2023. Descriptive statistics and average treatment effects (ATE) using propensity-score matching were employed to analyze our data. RESULTS: Our results indicated that both groups were homogenous regarding baseline characteristics. When we evaluated the ATE of fresh vs. frozen ET on the main outcomes, we discovered that only frozen ET significantly improved the pregnancy rates (ATE: 0.17, 95% CI: 0.04-0.30, p=0.011) and live birth rates (ATE: 0.36, 95% CI: 0.02-1.19, p=0.03). The miscarriage rates were similar between the two groups. None of the evaluated KIR genotypes had a significant influence on the ATE corresponding to fresh and frozen ET. CONCLUSIONS: KIR screening is not necessary before an IVF cycle, except for specific situations such as recurrent pregnancy loss or recurrent implantation failure.

Evaluation and application of the CROPGRO-soybean model for determining optimum sowing windows of soybean in the Nigeria savannas.

Soybean production is limited by poor soil fertility and unstable rainfall due to climate variability in the Nigeria savannas. There is a decline in the amount and duration of rainfall as one moves from the south to north of the savanna zones. The use of adapted soybean varieties and optimum sowing windows are avenues to increase productivity in the face of climate variability. Crop simulation models can be used as tools for the evaluation of alternative management options for a particular location, including fertilizer application rates, plant density, sowing dates and land use. In this study, we evaluated the performance of the Cropping System Model (CSM)-CROPGRO-Soybean to determine optimum sowing windows for three contrasting soybean varieties (TGX1835-10E, TGX1904-6F and TGX1951-3F) cultivated in the Nigeria savannas. The model was calibrated using data from ten field experiments conducted under optimal conditions at two sites (BUK and Dambatta) in Kano in the Sudan savanna (SS) agro-ecology over four growing seasons. Data for model evaluation were obtained from independent experiment for phosphorus (P) response trials conducted under rainfed conditions in two locations (Zaria and Doguwa) in the northern Guinea savanna (NGS) zone. The model calibration and evaluation results indicated good agreement between the simulated and observed values for the measured parameters. This suggests that the CROPGRO-Soybean model was able to accurately predict the performance of soybean in the Nigeria savannas. Results from long-term seasonal analysis showed significant differences among the agro-ecologies, sowing windows and the soybean varieties for grain yield. Higher yields are simulated among the soybean varieties in Zaria in the NGS than in Kano the SS and Jagiri in the southern Guinea savanna (SGS) agro-ecological zones. Sowing from June 1 to July 5 produced optimal yield of TGX1951-3F and TGX1835-10E beyond which yield declined in Kano. In Zaria and Jagiri the simulated results show that, sowing from June 1 to July 12 are appropriate for all the varieties. The variety TGX1951-3F performed better than TGX1904-6F and TGX1835-10E in all the agro-ecologies. The TGX1951-3F is, therefore, recommended for optimum grain yield in the savannas of northern Nigeria. However, the late maturing variety TGX1904-6F is not recommended for the SS due to the short growing season in this zone.

Pseudoxanthoma elasticum in a patient with sickle cell disease: case report.

An 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya.

Fertility rate of epileptic women at Kenyatta National Hospital.

BACKGROUND: Reproductive health issues of women with epilepsy (WWE) are complex and multifaceted, and both epilepsy and antiepileptic drug (AEDs) use may alter fertility and pregnancy outcomes in these women. OBJECTIVE: To determine the fertility rate of women with epilepsy at Kenyatta National Hospital (KNH). DESIGN: Cross-sectional study. SETTING: Neurology clinic, KNH, Nairobi, Kenya, between October 2006 and March 2007. SUBJECTS: A total of 191 women with epilepsy (aged 15-49 years) who had been epileptic for at least one year were interviewed regarding their pregnancy and birth histories, and the information validated with medical records where available. RESULTS: The general fertility rate (GFR) for reproductive-aged epileptic women for the three-year period (2003-2006) preceding the study was 46 livebirths per 1000 women-years (95% CI 35.13-63.59). CONCLUSION: Fertility rate in epileptic women is decreased by two thirds (compared to that of general population of women in Kenya). Reasons for this are probably miltifactorial.

Benign positional vertigo and hyperuricaemia.

OBJECTIVE: To find out if there is any association between serum uric acid level and positional vertigo. DESIGN: A prospective, case controlled study. SETTING: A private neurological clinic. SUBJECTS: All patients presenting with vertigo. RESULTS: Ninety patients were seen in this period with 78 males and 19 females. Mean age was 47 +/- 3 years (at 95% confidence level) with a standard deviation of 12.4. Their mean uric acid level was 442 +/- 16 (at 95% confidence level) with a standard deviation of 79.6 umol/l as compared to 291 +/- 17 (at 95% confidence level) with a standard deviation of 79.7 umol/l in the control group. The P-value was less than 0.001. CONCLUSION: That there is a significant association between high uric acid and benign positional vertigo.

Major histocompatibility complex class I and class II polymorphism in chronic idiopathic demyelinating polyradiculoneuropathy.

Thirty-one chronic idiopathic demyelinating polyradiculoneuropathy (CIDP) patients have been typed for HLA-A, -B and -C antigens serologically and for HLA-DR, -DQ and -DP class II genes by RFLP analysis. Our results confirm a previously reported slight association with HLA-B8 and identify a stronger association with HLA-Cw7.

High-performance liquid chromatographic assay for simultaneous estimation of aminoglutethimide and acetylaminoglutethimide in biological fluids.

A simple rapid high-performance liquid chromatographic assay for simultaneous estimation of aminoglutethimide and its acetylated metabolite acetylamidoglutethimide in plasma, saliva, and urine is described. This assay is suitable for pharmacokinetic studies in normal subjects and patients receiving other medication in addition to aminoglutethimide.

Detection of antibodies to Leishmania donovani in animals in a kala-azar endemic region in eastern Sudan: a preliminary report.

The prevalence of antibodies against Leishmania donovani in selected domestic and wild animal species in 2 villages in Sudan with active L. donovani transmission in humans was investigated. Screening of domestic animals (donkeys, cows, sheep, goats, camels and dogs) with the direct agglutination test (DAT) detected reaction rates above the cut-off titres in donkeys (68.7%), cows (21.4%) and goats (8.5%), and which were also found in wild rats (5.5%). Sera of sheep, camels and dogs had a weak agglutination reaction below the cut-off titre. Testing of the same sera by enzyme-linked immunosorbent assay (ELISA), against a lysate of L. donovani promastigotes, showed reaction rates above the cut-off optical density in cows (47.6%), goats (13.6%), and in rats (4.1%). No Leishmania parasite was isolated from spleen, liver, bone-marrow or spleen of Nile rats.

Multiple sclerosis: epidemic in Kenya.

Over a period of five years, November, 1983 to October, 1988 six cases of definite multiple sclerosis were identified at Kenyatta National Hospital. Four were females and two were males. Age of onset of disease ranged from 12 years to 30 years. Their mode of presentation, clinical features and prognosis is the same as that of multiple sclerosis seen at higher latitudes. The consequences of misdiagnosis to the patient is discussed. A theory is put forward to explain the increased numbers of MS seen recently as compared to the past decades.

Unusual form of motor neuron disease in Kenya.

Over the period November 1978 to October 1988, 46 cases of motor neuron disease were seen at Kenyatta National Hospital, Nairobi. One case was seen in private practice. A bimodal age distribution of the disease was identified with a peak in the fourth decade of life and another peak in the sixth decade of life. The disease seen in the fourth decade of life was different as seen in other parts of the world in that the majority of patients tended to present with very rapidly progressive disease despite the primary presentation with limb symptoms and signs. Serum cholinesterase activity in five of these patients and five of the classical motor neuron disease revealed no abnormalities. This unusually rapidly progressive disease in young adults has not been described anywhere. The disease seen in older age groups and especially in patients over fifty years of age was not different from the one seen in other parts of the world.

Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report.

A 27 year old female with AIDS and disseminated histoplasmosis is presented. The clinical features include fever, weight loss, productive cough, splenomegaly and moderate pallor. The initial working diagnosis was pulmonary tuberculosis. The diagnosis of disseminated histoplasmosis was made terminally from bone marrow aspirate examination. Disseminated histoplasmosis with its varied clinical picture is likely to be missed in a patient with AIDS, and therefore a high index of suspicion is necessary for diagnosis.

PIP: A 27-year old female from Nairobi was admitted to the medical wards of the Kenyatta National Hospital in May 1991. She presented with a 4-week history of productive cough, fever, weight loss, and night sweats. She acknowledged a history of contact with a patient known to have pulmonary tuberculosis. She has never received a blood transfusion. She was single and para 3 + 0. Examination revealed a sick patient, with moderate pallor, fever of 38 degrees Celsius, and who was wasted with moderate dehydration and oral thrush. There was no finger clubbing, lymphadenopathy, or pedal edema. Chest examination revealed bilateral basal pneumonia. The spleen was palpable 4 cm below the costal margin; the liver was not enlarged. The rest of the examination was normal. On admission, complete blood count showed a haemoglobin of 5.4 g/dl, total white cells were 12.5 x 10-9/L, with 82% polymorphonuclear cells and 18% lymphocytes, erythrocyte sedimentation rate (ESR) was 85 mm/hour, and platelet count was normal. The anemia was normocytic, normochromic, and no malaria parasites were seen. Urea and electrolytes and liver function tests were normal. Sputum showed no acid fast bacilli on Ziel-Neelson Stain. HIV-1 antibodies were positive by enzyme-linked immunosorbent assay (ELISA) and Western blot. Bone marrow aspirate revealed a hypercellular marrow with reversed M:E ration, dyserythropoesis, reticulum cell hyperplasia, plentiful golden yellow pigment, and clumps of Histoplasma capsulatum. Chest X-ray showed bilateral basal pneumonia. She was treated with antibiotics and intravenous fluids, but she remained febrile, her general condition progressively deteriorated, and she died a week after admission. Treatment for histoplasmosis had not been commenced, and no postmortem examination was carried out.

[Classification of the avian summer population of the Western Siberian plain]. / Klassifikatsiia letnego naseleniia ptits zapadno-sibirskoi ravniny.

The proposed classification system reflects the difference between the three population systems: unbuilt land, built-up land, and aquatic-semiaquatic communities. Two superorder groups--north and median--further divided into types were recognized in each of the systems. Most types are divided into subtypes, classes, and subclasses (and sometimes genera of the population). The estimation of the power and generality of the influence of environmental factors (their variability correlates with heterogeneity of the avian population) has demonstrated that forestation of the territory is most significant in the first half of summer on the western Siberian Plain. The composition of the forest-forming species and zoning are less affected. The influence of moisture and hydration is 2-3 times less significant; mesorelief is 4-5 times less significant; and productivity (feeding capacity) and anthropogenic influence are 7-9 times less significant.

Where's the difference? Presentation of nosocomial infection in critically ill trauma versus general surgery patients.

BACKGROUND: Diagnosing infection efficiently is integral to managing critically ill patients. Knowing if and how trauma and general surgery patients differ in their presentation of new infectious complications could be useful. We hypothesized these populations would differ in presentation in the intensive care unit (ICU). METHODS: We analyzed data collected prospectively from all 1,657 trauma and general surgery patients admitted to the surgical and trauma ICU (STICU) over a 21-month period. Clinical data from the first day of a newly diagnosed infection were compared for trauma (82% of the series) and general surgery (18%) patients. RESULTS: A total of 10,424 STICU days were included, and 267 nosocomial infections were diagnosed. Trauma patients were younger (50 vs. 62 years; p<0.001) and more likely to be male (78% vs. 46%; p<0.001) than were general surgery patients. Similar percentages of the two groups were infected (11% and 13%, respectively), and infections occurred after a similar number of days in the STICU. The mean maximum temperature on the day prior to diagnosis was higher in trauma patients (38.4°C vs. 37.7°C; p<0.001), and the mean leukocyte count was lower (13,500 vs. 15,800 10(6)/L; p=0.013). General surgery patients were more likely to be hypotensive (13% vs. 2%; p=0.002) and to have a positive fluid balance >2 L on the first day of infection (27% vs. 13%; p=0.02). Respiratory infections were more common in trauma patients (40% vs. 7%; p<0.001), and urinary tract infections were less common (19% vs. 36%; p=0.011). CONCLUSION: Differences exist in how new infections manifest in trauma and general surgery patients in the ICU. General surgery patients appeared sicker on their first day of infection, as evidenced by a higher leukocyte count, lower blood pressure, and substantial positive fluid balance. Intensivists may need differing thresholds for triggering infection workups when employed in a mixed unit.

Creutzfeldt-Jakob disease in Kenya.

OBJECTIVE: To study the pattern of occurrence of Creutzfeldt-Jakob disease (CJD) in Kenya. Study design Prospective, cross-sectional, descriptive study of clinical, encephalographic and natural history of CJD, backed by histology in as many patients as possible. METHODS: Consecutive patients presenting with the criteria laid down by WHO expert committee for diagnosis of CJD were recruited between January 1990 and May 2004. We analysed the clinical features and electroencephalography of all participants and took brain biopsies from four patients. RESULTS: There were four definite, seven probable and two possible cases. The electroencephalographic and histological features were typical of sporadic CJD. CONCLUSION: Sporadic CJD occurs in Kenya and the clinical, encephalographic and histological features were no different to those described elsewhere. Although we did not see variant, hereditary and iatrogenic forms of CJD, neurologists should not exclude these in making diagnoses.

Skull radiograph measurements of normals and patients with basilar impression; use of Landzert's angle.

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

Gas--liquid chromatographic assay of aminoglutethimide and a high-performance liquid chromatographic assay for its acetyl metabolite in biological fluids.

A rapid, sensitive and selective gas--liquid chromatographic assay for aminoglutethimide is described. The same extraction procedure may be employed prior to a high-performance liquid chromatographic assay for acetamidoglutethimide which is also detailed. Both assays are suitable for the study of the pharmacokinetics of aminoglutethimide and acetamidoglutethimide in biological fluids in man.