Pattern of hypertensive kidney disease in a black Kenyan population.

BACKGROUND: Hypertensive kidney disease is a major cause of morbidity and mortality. Its pattern displays geographical and ethnic variations. Data on these patterns are important for informing management and prevention strategies, but on Kenyans such data are scarce. OBJECTIVE: By means of a retrospective study at Kenyatta National Hospital, Nairobi, we aimed to describe the pattern of hypertensive kidney disease in a black Kenyan population. METHODS: Records of hypertensive patients who had impaired kidney function between January 2000 and December 2010 were examined for mode of diagnosis, age, gender, comorbid factors, treatment and outcome. Data were analyzed using the Statistical Package for Social Sciences, version 16.0 for Windows, and are presented using tables and bar charts. RESULTS: A total of 114 cases (72 males, 42 females) were analyzed. The mean age was 42.7 years (range 12-83), peaking at 51-70 years. The male to female ratio was 1.7:1. Comorbid factors included left ventricular hypertrophy (21.1%), congestive heart failure (15.8%), alcohol (11.4%), cerebrovascular accidents, smoking and retinopathy (10.5% each). Multiple comorbid factors were present in 8.8% of the cases. The majority (52.6%) of the patients survived on hemodialysis, 8.8% underwent successful renal transplant and 22.8% died. CONCLUSION: Hypertensive kidney disease affects all age groups, males more than females. It is commonly associated with other cardiovascular conditions and carries a high morbidity. Vigilant control of blood pressure is recommended.

Pulmonary thromboembolism in an East African tertiary referral hospital.

Pulmonary thromboembolism (PTE) is a frequent cause of mortality in Kenya, but its characteristics are hardly reported in Subsaharan Africa. To describe the pattern of PTE among black Africans, in a Kenyan referral hospital. Retrospective study at Kenyatta National Hospital (KNH), Nairobi, Kenya. Records of patients seen between January 2005 and December 2009 were examined for mode of diagnosis, comorbidities, age, gender, treatment and outcome. Data were analyzed using SPSS version 15.0 and are presented in tables and bar charts. One hundred and twenty-eight (60 male; 68 female) cases were analyzed. Diagnosis was made by clinical evaluation, a Well's score of >4.0, high D-dimer levels and ultrasound demonstration of a proximal deep venous thrombosis (DVT, 35.9%), lung spiral computer tomography (CT, 50%), multidetector CT (7.8%) and angiography (6.3%). Most frequent comorbidities included DVT (36%); hypertension (18.8%); pulmonary tuberculosis (PTB, 12.5%); HIV infection (10.9%), pueperium, diabetes mellitus and cigarette smoking (9.4% each). Mean age was 40.8 years (range 5-86 years) with a peak between 30 and 50 years. Over 46% of patients were aged 40 years and less. Male:female ratio was 1:1.13. All the patients were treated with anticoagulants and thrombolytics with only one having embolectomy. Ninety-two patients (71.9%) recovered, 18.8% of them with cor pulmonale, while 28.1% died. PTE is not uncommon in Kenya. It affects many individuals below 40 years without a gender bias, and carries high morbidity and mortality. Associated comorbidities include venous thrombosis, lifestyle conditions and communicable diseases. Control measures targeting both are recommended.

Pattern of acute myocardial infarction in an African country.

OBJECTIVE: The objective of this study was to describe the pattern of acute myocardial infarction in an African country. These data are important for prevention strategies but are scarce from sub-Saharan African countries and altogether absent from Kenya. METHODS AND RESULTS: This was a retrospective study done at Kenyatta National Hospital, Kenya. Cases of acute myocardial infarction admitted to the hospital between January 2000 and December 2009 were examined for mode of diagnosis, age, gender, risk factors, and outcome. Only those with confirmed diagnosis were included. Results were analysed by SPSS version 13.0 for Windows, and are presented in tables and bar charts. One hundred twenty cases (80 men; 40 women) were analysed. Clinical diagnosis had been confirmed by electrocardiography and cardiac enzymes (87.5%), angiography (8.3%) and echocardiography (4.2%). Mean age was 56.8 years and male:female ratio 2:1. Common risk factors were hypertension (35%), diabetes mellitus (20.8%), smoking and infection 12.5% each and alcohol (10.8%). The majority (50.8%) of the patients recovered, 44.2% developed congestive cardiac failure and only 5% died. CONCLUSION: Acute myocardial infarction is not uncommon in Kenya. Over 30% of the patients are 50 years and younger and it carries a high morbidity from heart failure. Risk factors comprise a combination of non-communicable diseases, namely hypertension and diabetes mellitus, coexisting with infections. Control measures targeting both categories are recommended.

Pattern of congestive heart failure in a Kenyan paediatric population.

BACKGROUND: Heart failure in children is a common cause of morbidity and mortality, with high socio-economic burden. Its pattern varies between countries but reports from Africa are few. The data are important to inform management and prevention strategies. OBJECTIVE: To describe the pattern of congestive heart failure in a Kenyan paediatric population. METHODS: This was a retrospective study done at Kenyatta National Hospital, Nairobi Kenya. Records of patients aged 12 years and younger admitted with a diagnosis of heart failure between January 2006 and December 2010 were examined for mode of diagnosis, age, gender, cause, treatment and outcome. Data were analysed using the Statistical Programme for Social Scientists version 16.0 for windows, and presented in tables, bar and pie charts. RESULTS: One hundred and fifty-eight cases (91 male, 67 female) patients' records were analysed. The mean age was 4.7 years, with a peak at 1-3 years. The male: female ratio was 1.4:1. All the cases were in New York Heart Association (NYHA) class II-IV. Evaluation of infants was based on the classification proposed by Ross et al. (1992). Diagnosis was made based on symptoms and signs combined with echocardiography (echo) and electrocardiography (ECG) (38%); echo alone (12.7%); ECG, echo and chest X-ray (CXR) (11.4%); and ECG alone (10.8%). The underlying cause was established on the basis of symptoms, signs, blood tests, CXR, echo and ECG results. Common causes were infection (22.8%), anaemia (17.1%), rheumatic heart disease (14.6%), congenital heart disease (13.3%), cardiomyopathy (7.6%), tuberculosis and human immunodeficiency virus (6.9% each); 77.9% of patients recovered, 13.9% after successful surgery, and 7.6% died. CONCLUSION: Congestive heart failure is not uncommon in the Kenyan paediatric population. It occurs mainly before five years of age, and affects boys more than girls. The majority are due to infection, anaemia, and rheumatic and congenital heart diseases. This differs from those in developed countries, where congenital heart disease and cardiomyopathy predominate. The majority of children usually recover. Prudent control of infection and correction of anaemia are recommended.

Cardiovascular causes of death in an east African country: an autopsy study.

BACKGROUND: The spectrum of cardiovascular diseases varies between countries. Data from east Africa is scarce, but important in formulating disease management strategies. The aim of this study was to describe the spectrum of cardiovascular causes of death in Kenya. METHODS: One hundred and thirty four autopsy cases of cardiovascular related deaths examined at the Department of Human Anatomy, University of Nairobi, from December 2005 to November 2009 were analyzed for disease type, age and gender distribution. Only cases in which cardiovascular disease was the most likely cause of death were included. Data was analyzed using SPSS version 15.0 for Windows and presented using tables and bar graphs. RESULTS: Cardiovascular causes comprised 13.2% of all autopsy cases. Common conditions included myocardial infarction (18.7%), cardiomyopathy (17.2%), subarachnoid hemorrhage (15.7%), pulmonary thromboembolism (14.2%), ruptured aortic aneurysm (11.2%) and hypertensive heart disease (9.0%). Infective pericarditis and rheumatic heart disease comprised 7.5% and 6.7%, respectively. Mean age was 50.4 years, peaking at 40-60 years, with 56.7% aged 50 years and younger. Male: female ratio was 2.7:1. CONCLUSIONS: Cardiovascular disease contributes more than 13% of overall mortality in Kenya. Myocardial infarction is the commonest, while rheumatic heart disease is the rarest. It is predominantly male and mainly affects those aged under 50 years. This suggests that non-communicable diseases, while predominant, overlap with infectious conditions as causes of cardiovascular mortality. A search for, and the prevention of, risk factors, combined with prudent management of infection, are recommended.

Pattern of aortic aneurysms in an African country.

OBJECTIVE: We sought to describe the regional, age, and sex distribution; diagnosis; treatment; and outcome of aortic aneurysms in a Kenyan population. METHODS: This was a retrospective study at Kenyatta National Hospital, Kenya. Records of black African patients whose final diagnosis was aortic aneurysm over the period from January 1998 to December 2007 were examined. Frequencies and means are presented in tables and bar charts. RESULTS: Two hundred sixty-four (92 male and 172 female patients) files were analyzed. The mean age was 56.15 years. Two hundred twenty-three (84.5%) aneurysms occurred in the abdominal aorta, followed by the descending aorta (7.5%), ascending aorta, (3.8%) and arch (1.9%). In 2.3% of cases, both the abdominal and thoracic aortas were affected. The male/female ratio was 1:1.9. Pain with swelling or a pulsatile mass was the predominant feature. More than 50% of the cases were diagnosed by means of ultrasonographic analysis. Sixty-one (23.1%) aneurysms were ruptured, and of this group, 44 (72.1%) patients died. Successful open surgical repair was done in 157 (59.5%) patients. Hypertension was a comorbidity in 137 (51.9%) cases. CONCLUSIONS: Aortic aneurysms in Kenya show abdominal segment and female predominance, occur 10 to 15 years earlier than in white populations, and carry high mortality from rupture. Hypertension was the leading associated risk factor. Ultrasonographic screening and control of blood pressure might be useful preventive measures.

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.

Vasa vasora in the tunica media of goat aorta / Vasa vasora en la túnica media de la aorta de cabra

This study aimed at describing the distribution of vasa vasora in the tunica media of various parts of goat aorta, since this influences the physico-mechanical properties and disease occurrence. Specimens were obtained from ascending, arch, each vertebral level of descending thoracic and various segments of abdominal aorta of sixteen healthy adult male domestic goats (Capra hircus). They were fixed in 10 percent formaldehyde solution, and routinely processed for paraffin embedding. Seven micron thick sections were stained with Mason's Trichrome stain. Vasa vasora are present in the tunica media of all the aortic segments. In the proximal segments, they co-localize with muscle islands found in the adventitial half. Their density declines caudally, but they are still present in the tunica media even in the abdominal aorta where the thickness is less than 0.5mm and elastic lamellae less than 29. Vasa vasora in the goat aortic tunica media penetrate into the luminal half and are present even in relatively thin segments. This extent, which may enhance vascular health, suggests that the goat aortic wall is very active, a feature probably related to auxillary pump function of the muscle islands in the aortic wall.

El objetivo de este estudio fue describir la distribución de vasa vasora en la túnica media de diversas partes de la aorta de cabra, ya que esto influye en las propiedades físicas y la aparición de enfermedades. Las muestras se obtuvieron de 16 cabras machos adultos sanos (Capra hircus) desde la porción ascendente del arco aórtico, segmentos torácicos descendentes y de la parte abdominal de la aorta. Las muestras se fijaron en solución de formol al 10 por ciento, y fueron sometidas a procesamiento de rutina para inclusión en parafina. Secciones de siete micras de grosor se tiñeron con reacción tricrómica de Masson. Vasa vasora están presentes en la túnica media de todos los segmentos de la aorta. En los segmentos proximales, que localizan con islas de músculo que se encuentra en la mitad de la adventicia. Su densidad disminuye en sentido caudal, pero aún están presentes en la túnica media, incluso en la parte abdominal de la aorta, donde el espesor es inferior a 0,5 mm y láminas elásticas menos de 29. Vasa vasora en la túnica media de la aorta de la cabra penetran en el medio luminal y están presentes incluso en segmentos relativamente delgados. Esta medida, que puede mejorar la salud vascular, sugiere que la pared aórtica de la cabra es muy activa, una característica probablemente relacionada con la función de la bomba auxiliar de las islas del músculo en la pared aórtica.

Pattern of femoro-popliteal aneurysms in an African population

Objective: To describe the pattern of femoro-popliteal aneurysms in an African Kenyan population. Patients and methods: Records of African in-patients with diagnosis of femoral or popliteal aneurysms admitted at the Kenyatta National Hospital, Nairobi, Kenya, from January 1998 to December 2007 were examined for presentation, diagnosis, risk/comorbid factors, site, age, and gender distribution. Data were analyzed using SPSS 13.0 and presented using tables. Results: Femoro-popliteal aneurysms constitute 33 out of 96 of peripheral cases (34.4 percent). The most common presentations were pulsatile mass (48.5 percent) and pain and swelling (33.3 percent). Pain alone and bleeding occurred in 9.1 percent each. Diagnosis was performed through Doppler ultrasound (45.5 percent), angiography (30.3 percent) and ultrasonography (24.3 percent). Aneurysms were associated with trauma (51.5 percent), atherosclerosis (21.2 percent), smoking (9.1 percent) and hypertension (6.1 percent). Site distribution was common femoral (33.3 percent), superficial femoral (36.4 percent) and popliteal (30.3 percent). Mean age was 46 years (range 13-79 years); with 20 (60.6 percent) of them occurring in individuals aged 50 years and younger. Male:female ratio was 15:1. Conclusion: In the present study, femoro-popliteal aneurysms constituted less than 40 percent of peripheral aneurysms, and superficial femoral artery was the most common site. They occurred predominantly in males aged 50 years and younger and were associated mainly with trauma and atherosclerosis. Prevalence, site and age distribution of these aneurysms in the Kenyan population differs from that described in studies of Caucasian populations.

Objetivo: Descrever o padrão de aneurismas femoro-poplíteos em uma população africana do Quênia. Pacientes e Métodos: Prontuários de pacientes africanos internados com o diagnóstico de aneurisma femoro-poplíteo no Hospital Kenyatta, Nairóbi, Quênia, de janeiro de 1998 a dezembro de 2007 foram examinados quanto a apresentação, diagnóstico, fatores de risco/comorbidades, local, idade e gênero. Os dados foram analisados usando o Program SPSS 11.50 e apresentados em tabelas. Resultados: Aneurismas femoro-poplíteos constituem 33 dos 96 casos de aneurisma periférico (34,4 por cento). As apresentações mais comuns foram massa pulsátil (48,5 por cento) e dor e inchaço (33,3 por cento). Dor isolada e sangramento ocorreram em 9,1 por cento cada. O diagnóstico foi feito por ultrassonografia Doppler (45,5 por cento), angiografia (30,3 por cento) e ultrassonografia simples (24,5 por cento). Aneurismas foram associados a trauma (51,5 por cento), aterosclerose (21,2 por cento), tabagismo (9,1 por cento) e hipertensão arterial (6,1 por cento). A distribuição por locais foi femoral comum (33,3 por cento), femoral superficial (36,4 por cento) e poplítea (30,3 por cento). A média de idade foi de 46 anos (variando de 13 a 79 anos), com 20 casos (60,6 por cento) ocorrendo em indivíduos com 50 anos de idade ou menos. A relação masculino:feminino foi de 15:1. Conclusão: No presente estudo, aneurismas femoro-poplíteos constituíram menos de 40 por cento dos aneurismas periféricos, e a artéria femoral superficial foi o local mais comum. Eles ocorreram predominantemente em homens com idade igual ou menor que 50 anos e foram associados principalmente a trauma e aterosclerose. A prevalência, local e distribuição destes aneurismas diferem das descritas nas populações brancas.