ABSTRACT
INTRODUCTION: HIV-associated nephropathy (HIVAN) has been strongly linked to African ancestry. However, studies have demonstrated wide variability in the prevalence of HIVAN in different sub-Saharan African populations. Accurate assessment of the disease burden is important because antiretroviral therapy (ART) is increasingly available and may prevent progression to end-stage renal disease. METHODS: We prospectively screened ART-naïve, afebrile, nonhypertensive, and nondiabetic adults attending a large HIV care program in Western Kenya for the presence of albuminuria (dipstick albumin ≥ trace or urine albumin to creatinine ratio [UACR] ≥ 30 mg/g). Those with albuminuria confirmed on 2 occasions, subject to consent, underwent kidney biopsy. RESULTS: Among 523 subjects screened, 85 (16.3%) had albuminuria on the initial screen, and persistent albuminuria was confirmed in 32 of the 53 (60%) who returned for confirmatory testing. A total of 27 subjects with persistent albuminuria underwent biopsy. The median age was 34 years (interquartile range [IQR] 30-42 years), and 63% were female. The median CD4 count was 369 cells/µl (IQR 89-492 cells/µl). Renal function was normal in 92%. Median UACR was 257.5 mg/g (IQR 93.5-543 mg/g), and 92% had UACR < 1 g/g. No subject had histologic features consistent with HIVAN; 41% had acute interstitial nephritis (AIN); 33% had nonspecific findings, and 2 patients had arteriosclerosis. Focal segmental glomerulosclerosis, acute postinfectious glomerulonephritis, chronic interstitial nephritis, pyelitis, and papillary sickling were seen in 1 patient each. DISCUSSION: Among ART-naïve adults with persistent albuminuria at a referral center in Western Kenya, we observed no cases of HIVAN. AIN was the most common cause of persistent proteinuria in this setting.
ABSTRACT
BACKGROUND: Awareness of effects of long term use of computer and application of ergonomics in the computer workstation is important for preventing musculoskeletal disorders, eyestrain and psychosocial effects. OBJECTIVES: To determine the awareness of physical and psychological effects of prolonged computer usage and application of ergonomicsin the workstation. DESIGN: One hundred and eighty one people were interviewed from tertiary educational institutions, telecommunications and media houses within Nairobi, Kenya. SUBJECTS: Descriptive cross sectional study. RESULTS: Majority (89.8%) of the respondents felt that prolonged computer use had an adverse effect on their health, with only 12.4% having received formal training on the same. Assessment of their workstations revealed the most applied ergonomic measure as feet placement on the floor: 100% (181) followed by correct monitor placement with 94.4% (171) fulfilling the requirements. The least applied ergonomic measures were non reflecting wall paint: 5% (9) and adjustable desk 9.9% (18). CONCLUSION: There is awareness among computer users on the effects of prolonged computer use but there is limited application of ergonomic measures.