Prevalence of femoral vein duplication: systematic review and metaanalysis.

Background: Duplication of the femoral vein is an important anatomical variation of the venous anatomy which has been shown to have an impact on the diagnosis of deep venous thrombosis by compression ultrasonography. The presence of duplication may result in false negative findings while evaluating for deep venous thrombosis, with serious consequences such as pulmonary embolism and death. This metaanalysis aims to determine the pooled prevalence of duplicated femoral veins. Methods: A systematic search was conducted through the major databases PubMed, Hinari, Embase and Medline to identify studies eligible for inclusion. Appropriate data were extracted and pooled into a random-effects metaanalysis using MetaXL software. The primary and secondary outcomes of the study included the pooled prevalence of duplicated femoral veins and the prevalence of bilaterally duplicated femoral veins, respectively. Results: A total of 11 studies (n = 3,682 limbs) were included. The overall pooled prevalence of duplicated femoral veins was 19.7% (95% CI 11-30). There was a significant difference in prevalence between cadaveric studies (2%, 95% CI 1-4) and imaging studies (25%, 95% CI 17-34). Conclusion: Duplication of the femoral vein is a common variation in the lower limbs. Routine watch-out should be practiced especially when performing lower limb Doppler studies in cases of deep venous thrombosis in order to avoid misdiagnosis and improve diagnostic accuracy.

Anatomical Variations in the Origin of the Lumbar Artery: A Cadaveric Study Augmented by CT Findings.

BACKGROUND: Anatomical variations of lumbar arteries predispose them to iatrogenic injury during endovascular intervention or surgery. Due to limited morphological data on lumbar arteries in our setting, we aimed to determine their variant anatomy among Kenyans. METHODS: We performed the study on 90 cadaveric specimens and 120 computed tomography (CT) scans. Cadavers were dissected to expose the aorta and the lumbar arteries emerging from them. The number, origins, location relative to the vertebral bodies, and relations to aortic bifurcation were determined in cadavers and CT scans. Data were analyzed using SPSS (version 21.0). RESULTS: On average, 3 (3/90 [3.3%]), 4 (63/90 [70%]) or 5 (24/90 [26.7%]) pairs of lumbar arteries were observed among the cadaveric specimens, whereas 4 (100/120 [83.3%]) or 5 (20/120 [16.7%]) pairs were observed in CTs. Differences in the number of pairs observed in the cadaveric versus CT study were not statistically significant (P = .542). There were no sex differences in the number of lumbar artery pairs observed in CT scans (P = .178). The first 3 lumbar artery pairs had a single-origin, whereas the fourth lumbar artery had a common-stem origin. The first, second, and third lumbar arteries mostly originated at the upper third of their respective vertebral bodies. The fourth lumbar artery predominantly originated at the lower third. CONCLUSION: Our study's findings show unique variation in the lumbar arteries' relation to the vertebral bodies and the distances between artery pairs. LEVEL OF EVIDENCE: IV (cross-sectional study). CLINICAL RELEVANCE: Variations in the anatomy of the lumbar arteries should be taken into consideration, especially in surgical or interventional procedures to avoid inadvertent injury of the vessels.

Laparoscopic surgery during the COVID-19 pandemic: detection of SARS-COV-2 in abdominal tissues, fluids, and surgical smoke.

BACKGROUND: There are still concerns over the safety of laparoscopic surgery in coronavirus disease 2019 (COVID-19) patients due to the potential risk of viral transmission through surgical smoke/laparoscopic pneumoperitoneum. METHODS: We performed a systematic review of currently available literature to determine the presence of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in abdominal tissues or fluids and in surgical smoke. RESULTS: A total of 19 studies (15 case reports and 4 case series) comprising 29 COVID-19 patients were included. The viral RNA was positively identified in 11 patients (37.9%). The samples that tested positive include the peritoneal fluid, bile, ascitic fluid, peritoneal dialysate, duodenal wall, and appendix. Similar samples, together with the omentum and abdominal subcutaneous fat, tested negative in the other patients. Only one study investigated SARS-COV-2 RNA in surgical smoke generated during laparoscopy, reporting negative findings. CONCLUSIONS: There are conflicting results regarding the presence of SARS-COV-2 in abdominal tissues and fluids. No currently available evidence supports the hypothesis that SARS-COV-2 can be aerosolized and transmitted through surgical smoke. Larger studies are urgently needed to corroborate these findings.

Prevalence and pubo-umbilical index of pyramidalis muscle in a select Kenyan population.

PURPOSE: Pyramidalis is a lower anterior abdominal wall muscle that is considered vestigial and shows variations in prevalence and size. It's been utilized as an anatomical landmark and harvested for use in various surgical procedures. Despite knowledge of its clinical importance, data on the prevalence of pyramidalis remain absent from the Kenyan population with few studies globally reporting on its pubo-umbilical index. We therefore aimed to determine the prevalence and relative lengths (pubo-umbilical index) of pyramidalis muscle in a sample Kenyan population. MATERIALS AND METHODS: Fifty-two cadavers (41 males, 11 females) from the Department of Human Anatomy, University of Nairobi were used. Prevalence and length of the muscle (l) were established, and the distance between pubic symphysis and umbilicus (L) measured and used to calculate pubo-umbilical index (l/L ×100%). Independent and paired T tests were done, using SPSS® version 22. A p value of ≤ 0.05 was considered statistically significant at a 95% confidence interval. RESULTS: Pyramidalis was present in 84% (44) of cadavers; 83% (43) bilaterally, 2% (1) unilaterally, and 85.4% (35) in males, 81.8% (9) in females. Mean length in males and females was 71.8 ± 35 mm and 63.5 ± 37.5 mm, respectively. Mean pubo-umbilical index was 38% ± 18 (39 % ± 18 males, 35% ± 19 females). No statistically significant difference was found. CONCLUSION: Pyramidalis is a highly prevalent muscle in the Kenyan population and, hence, could be exploited for its clinical and surgical utilities. The muscle terminates largely within the 2nd quarter (25-50%) of the infra-umbilical linea alba measured from pubic symphysis. Its pubo-umbilical index would be useful to surgeons making midline infra-umbilical incisions and performing procedures involving the muscle.

Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients.

BACKGROUND: Emerging evidence suggests that a subset of coronavirus disease 2019 (COVID-19) patients may present with or develop cerebrovascular disease during the course of hospitalization. Whereas ischemic stroke in COVID-19 patients has been well described, data on intracranial hemorrhage (ICH) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of ICH in COVID-19 patients. METHODS: A systematic search of literature was conducted between November 1, 2019, and August 14, 2020, on PubMed and China National Knowledge Infrastructure (CNKI) to identify eligible studies. RESULTS: A total of 23 studies describing ICH in 148 COVID-19 patients were included. The pooled incidence of ICH in COVID-19 patients was 0.7% (95% CI 0.5-0.9), with low levels of inter-study heterogeneity observed (I2 = 33.6%, Cochran's Q = 12.05, p = 0.149). Most of the patients were elderly male patients (65.8%) with comorbidities, the most common being systemic hypertension (54%). Hemorrhage involving multiple cranial compartments was reported in 9.5% of cases. Single compartments were involved in the rest, with intraparenchymal hemorrhage (IPH) being the most common variety (62.6%) and intraventricular hemorrhage (IVH) the least common (1.4%). Half of these patients were on some form of anticoagulation. Overall, the mortality rate in the COVID-19 patients with ICH was about 48.6%. CONCLUSION: Although relatively uncommon among COVID-19 patients, ICH is associated with a high mortality rate. Early identification of patients at risk of developing ICH, particularly with comorbid conditions and on anticoagulant therapy, may be important to improve outcomes.

Coronavirus Disease 2019 (COVID-19) set to increase burden of atherosclerotic cardiovascular disease in Kenya.

The coronavirus disease 2019 (COVID-19), first reported in Kenya on March 13, 2020, is spreading rapidly. As of 30th June 2020, over 6,190 cases had been reported with a case fatality of 3.2%. Previous Coronavirus outbreaks have been associated with a significant burden of Cardiovascular disease. For COVID-19, however, there has been no direct reference to potential long-term cardiovascular effects, especially in Africa where atherosclerotic diseases are an emerging challenge. This article, therefore, aims at describing possible long-term effects on the burden of atherosclerotic disease among Kenyans. Available data indicate that COVID-19 and cardiovascular disease share pathomechanisms and risk factors which include ACE2 receptor invasion and renin-angiotensin system signaling, oxidative stress, systemic inflammation, and endothelial dysfunction. Further, SAR-COV-2 infection causes dyslipidemia, dysglycemia, kidney, and liver disease. These mechanisms and diseases constitute risk factors for the initiation, progression, and complications of atherosclerosis. In Kenya, the common risk factors for atherosclerotic cardiovascular disease, and COVID-19 comprising Hypertension, Diabetes Mellitus, Obesity, Cigarette Smoking, Respiratory Tract Infections, Pulmonary Thromboembolism, Chronic Obstructive Pulmonary Disease, and Renal disease are not uncommon and continue to increase. In essence, the prevalence of the common risk factors/comorbidities, between COVID-19 and CVD occurrence of ACE2 receptors on the endothelium, and hence pathomechanisms of SARS-COV-2 infection imply that COVID-19 may increase the burden of atherosclerotic disease in Kenya. All due care should be taken, to prevent and effectively manage the disease, to avert an imminent epidemic of atherosclerotic disease.

Morphometric Dimensions of the Calcaneus.

Calcaneal morphometric dimensions influence surgical treatment plans after injury. These dimensions display population heterogeneity, and there is a paucity of data in the setting of our hospital in Kenya. Further, estimation of calcaneal dimensions during reconstruction in comminuted fractures can be difficult. This cross-sectional study therefore aims to determine equations for estimation of these dimensions as well as provide local data. Sixty-four bilateral calcanei of adult indigenous Kenyans were obtained from the National Museum of Kenya and measured for maximum anteroposterior length, maximum height, cuboidal facet height, body height, and load arm length. The data were coded into SPSS software, and means were calculated. Paired t tests, independent t tests, and Pearson correlation tests were done, and linear regression model equations were developed. Data are presented using tables. In millimeters, the mean right and left values, respectively, were as follows: maximum anteroposterior length, 36.1063 and 35.3047; maximum height, 68.958 and 68.266; cuboidal facet height, 27.815 and 27.841; body height, 47.94 and 48.98; and load arm length, 18.83 and 17.93. Paired and independent t tests did not reveal statistically significant difference between the variables based on side or sex. Pearson correlational tests between the maximum length on each side and other variables revealed strong positive correlations, apart from the maximum width and load arm length on both sides. All correlational R2 values were statistically significant, apart from that of the maximum width bilaterally. The calcaneus in our setting also showed markedly reduced values compared with other populations. These findings, and the proposed equations we developed, may be considered in local calcaneal reconstruction.

Computed Tomography Scan Assessment of the Anatomy of the Pterygomaxillary Junction and Its Relevance in Le Fort I Osteotomy.

Knowledge of the morphometry and types of pterygomaxillary junction (PMJ) during Le-Fort I osteotomy is an important consideration in the reduction of intraoperative complications. The PMJ is known to display population variations and with the recent increase in these surgical interventions in Kenya, a detailed description of the PMJ is warranted. Computed tomography scan images of PMJ obtained from 63 patients were analyzed at the level of the posterior nasal spine to assess types and the morphometry of the PMJ. A fissure type of PMJ was present in 65.9% (83/126 sides) while a synostosis type was present in 34.1% (43/126). Bilateral fissures were found in 58.73% (37/63), bilateral synostosis in 26.98% (17/63), and an asymmetric PMJ in 15.25% (9/63). The average height, width, and thickness of the PMJ were 17.45 ±â€Š5.26 mm, 10.24 ±â€Š1.97 mm, and 6.40 ±â€Š1.97 mm respectively. Males had a significantly greater height (P = 0.003) and width (P = 0.000). The average width was greater in cases with a synostosis as compared with those with a fissure (P = 0.019). Average distance of greater palatine canal was 40.41 ±â€Š2.28 mm and 7.19 ±â€Š2.20 mm from the piriform rim and the pterygoid fossa respectively. The PMJ among Kenyans is characterized by a higher occurrence of synostosis, greater height, and thickness compared with previous findings from other populations. The results of this study can be helpful for surgeons in selecting the most appropriate techniques to achieve successful pterygomaxillary disjunction and minimize avoid attendant complications such as vascular and nerve injuries.

A meta-analysis of the relationship between anatomical variations of pulmonary veins and atrial fibrillation.

Background: Our aim was to provide an evidence-based assessment of the relationship between pulmonary vein variants and atrial fibrillation (AF).Methods: A comprehensive systematic search was performed on the databases PubMed, EMBASE, Cochrane library and Science Direct. Following assessment of eligibility and methodologic quality, data on PV variants were extracted and pooled into a meta-analysis.Results: A total of 12 studies (1337 cases and 1250 controls) were included. Presence of a right middle pulmonary vein was significantly associated with AF (OR = 1.85, 95% CI 1.26-2.72, p = .002). No significant association was however noted between presence of a common pulmonary vein ostia and AF. In the analysis of ostial diameters, the strongest association was observed between increased left common ostia diameter and AF (OR = 2.71, 95% CI 0.99-4.44, p = .002), followed by right superior (OR = 2.39, 95% CI 1.76-3.02, p < .00001), left superior (OR = 2.30, 95% CI 1.48-3.13, p < .00001), right inferior (OR = 2.19, 95% CI 1.69-2.69, p < .00001) and left inferior (OR = 1.79, 95% CI 1.25-2.34, p < .00001) pulmonary veins.Conclusion: The findings of the current study support the hypothesis that pulmonary vein variations predispose to AF. Further studies into the role of structural abnormalities of the pulmonary veins variations in the genesis of AF are recommended.

Cerebral Artery Hypoplasia in a Select Adult Kenyan Population.

Background Hypoplasia of cerebral arteries predisposes to stroke and cerebral aneurysms which have an increased incidence in sub-Saharan Africa. The frequency and pattern of cerebral artery hypoplasia, however, shows population variations, and data from the African population remain scanty. Objectives This study aimed to determine the percentage of hypoplasia in the anterior, middle, and posterior cerebral, anterior and posterior communicating, basilar, and vertebral arteries. Materials and Methods Sections of the basilar, vertebral, posterior, and anterior communicating arteries and anterior, middle, and posterior cerebral arteries were taken, processed for histology, and examined with a light microscope at ×40. The images of the vessels were taken by a photomicroscope and circumference analyzed with the aid of Scion image analyzer. The average diameter of 10 sections was taken to be the diameter of the artery in analysis. Hypoplasia was then defined as internal diameter ≤1 mm. Photographs of representative samples of asymmetry were taken, data were analyzed using SPSS, and gender differences were analyzed using the Student's test. Results were presented in tables. Results Two hundred and eighteen formalin-fixed brains of adult Kenyans at the Department of Human Anatomy, University of Nairobi, were studied. Of the 218, 48 brains (22%) did not have vessels with any form of hypoplasia while 170 (78%) did have vessels. Of these, anterior circulation hypoplasia (anterior cerebral artery and posterior communicating artery) was seen in 100 brains (46%) and posterior circulation hypoplasia (middle and posterior cerebral, basilar, and vertebral arteries) in 69 brains (32%). Conclusion Cerebral arterial hypoplasia is frequent in the select adult Kenyan population.

Surgical anatomy of the external branch of the superior laryngeal nerve: a systematic review and meta-analysis.

PURPOSE: To provide a comprehensive evidence-based assessment of the anatomical characteristics of the external branch of the superior laryngeal nerve (EBSLN). MATERIALS AND METHODS: A thorough systematic search was performed on the major electronic databases PubMed, EMBASE, Cochrane library, and ScienceDirect to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the EBSLN identification rate (total number of EBSLN identified divided by the total number of dissected hemilarynges) and the prevalence of various EBSLN types. RESULTS: A total of 56 studies (n = 13,444 hemilarynges) were included. The overall pooled EBSLN identification rate was 89.24% (95% CI 85.49-92.49). This rate was higher for cadaveric (95.00%; 95% CI 89.73-99.35) compared to that reported in intraoperative studies (86.99%; 95% CI 82.37-91.01). Significantly higher identification rates were reported for studies in which intraoperative nerve monitoring was used (95.90%; 95% CI 94.30-97.25) compared to those which only relied on direct visual identification of the EBSLN (76.56%; 95% CI 69.34-83.08). Overall, Cernea type IIa (nerves crossing the superior thyroid artery less than 1 cm above the upper edge of the superior thyroid pole) and Friedman type 1 (nerves running their entire course superficial to the inferior pharyngeal constrictor) were the most prevalent (41.84%; 95% CI 33.28-48.08 and 50%; 95% CI 29.90-65.62, respectively). The combined prevalence of Cernea IIa and IIb (nerves crossing the superior thyroid artery below the upper edge of the superior thyroid pole) was higher in intraoperative studies compared to that in cadaveric studies (64.3% vs 49.4%). The EBSLN coursed medial to the superior thyroid artery in 70.98% (95% CI 55.14-84.68) of all cases. CONCLUSION: The use of intraoperative nerve monitoring improves EBSLN identification rates. In light of the highly variable anatomical patterns displayed by the EBSLN, thorough pre-operative knowledge of its anatomy can be crucial in minimizing incidences of its iatrogenic injury.

Geometric features of vertebrobasilar arterial system in adult black Kenyans / Características geométricas del sistema arterial vertebrobasilar en kenianos negros adultos

Geometric features of vertebrobasilar system influence occurrence of posterior circulation atherosclerosis, aneurysms, stroke and neuroradiological procedures. These features show ethnic variation, but data from black Africans in Sub Saharan Africa are scarce. This study aimed to describe geometric features of vertebrobasilar system in a black Kenyan population. It was a descriptive cadaveric study at Department of Human Anatomy, University of Nairobi. One hundred and seventy three formalin-fixed adult brains of individuals (99 male; 74 female; Age range 20 - 79) who had died of non cerebrovascular causes were studied. Level and angle of confluence of vertebral artery; diameter, length and bifurcation angles of basilar artery were measured. Data were analysed by SPSS version 21 for windows. The student t - test was used to determine the sex differences at 95 % confidence interval. Data are presented in macrographs, tables and bar charts. Confluence of vertebral arteries occurred at the sulcus bulbopontinus in 79.8 %; rostral to it in 11.5 % and caudal to it in 8.7 % of cases. Mean angle of vertebral artery confluence was 46.7º and 68.9º in males and females respectively (p£0.042). Mean length of the basilar artery was 26.8 mm; 26.3 mm in males and 27.1 mm in females (p=0.465). Mean diameter was 3.52 mm; 3.32 mm in males and 3.72 mm in females (p=0.002). The mean angle of basilar artery bifurcation was 120.3º ± 15.2; 99.3º ± 32.9 in males and 140.3º ± 16.1 in females (p=0.024). It was wider than 90º in 82.9 % of males and 95.9 % females (p=0.032). In 85 (49.1 %) it was wider than 120º. The vertebrobasilar system in the Kenyan population has geometric features that constitute risk factors for atherosclerosis. These features display sex dimorphism which may explain differences in prevalence of atherosclerosis and aneurysms. Neurosurgeons and neurologists should be aware of these differences. Individuals with risk prone geometric features should be followed up for atherosclerosis.

Las características geométricas del sistema vertebrobasilar influyen en la aparición de aterosclerosis en la circulación posterior, aneurismas, apoplejía, detectados durante procedimientos neurorradiológicos. Estas características muestran variación étnica, pero los datos de los africanos negros en el África Subsahariana son escasos. Este estudio tuvo como objetivo describir las características geométricas del sistema vertebrobasilar en una población negra de Kenia. Fue un estudio descriptivo cadavérico en el Departamento de Anatomía Humana de la Universidad de Nairobi. Se estudiaron 173 cerebros adultos (99 varones, 74 mujeres, rango de edad 20-79), fijados en formalina, de individuos que habían fallecido por causas no cerebrovasculares. Se midieron el nivel y ángulo de confluencia de la arteria vertebral, diámetro, longitud y bifurcación de la arteria basilar. Los datos fueron analizados por SPSS versión 21 para Windows. La prueba t de Student se utilizó para determinar las diferencias de sexo con un intervalo de confianza del 95 %. Los datos se presentan en macrografías, tablas y gráficos de barras. La confluencia de las arterias vertebrales se produjo en el surco bulbopontino en el 79,8 %; rostral al surco en 11,5 % y caudal al surco en 8,7 % de los casos. El ángulo medio de la confluencia de la arteria vertebral fue 46,70 y 68,90 en hombres y mujeres, respectivamente (p£0,042). La longitud media de la arteria basilar fue de 26,8 mm; 26,3 mm en hombres y 27,1 mm en mujeres (p=0,465). El diámetro promedio fue de 3,52 mm; 3,32 mm en hombres y 3,72 mm en mujeres (p=0,002). El ángulo medio de la bifurcación de la arteria basilar fue de 120,30 ± 15,2; 99.30 ± 32,9 en hombres y 140,30 ± 16,1en mujeres (p=0,024). Era más amplio que 90º. En un 82,9 % de los hombres y 95,9 % de las mujeres (p=0,032) se observó un ángulo más amplio que 90°. En 85 (49,1 %) fue más amplio que 120°. El sistema vertebrobasilar en la población de Kenia tiene características geométricas que constituyen factores de riesgo para la aterosclerosis. Estas características muestran dimorfismo sexual que puede explicar las diferencias en la prevalencia de aterosclerosis y aneurismas. Los neurocirujanos y los neurólogos deben tener en cuenta estas diferencias. Las personas con características geométricas propensas al riesgo deben ser seguidas por aterosclerosis.

Histomorphological changes in the common carotid artery of the male rat in induced hypogonadism.

The role of androgens in the development of cardiovascular diseases remains controversial. The current study therefore sought to determine the changes in the histomorphology of the common carotid artery of the male rat in orchidectomy-induced hypogonadism. Twenty-two Rattus norvegicus male rats aged 2 months were used. The rats were randomly assigned into baseline (n=4), experimental (n=9), and control (n=9) groups. Hypogonadism was surgically induced in the experimental group by bilateral orchiectomy under local anesthesia. At experiment weeks 3, 6, and 9, three rats from each group (experimental and control) were euthanized, their common carotid artery harvested, and routine processing was done for paraffin embedding, sectioning, and staining. The photomicrographs were taken using a digital photomicroscope for morphometric analysis. Orchidectomy resulted in the development of vascular fibrosis, with a significant increase in collagen fiber density and decrease in smooth muscle and elastic fiber density. Moreover, there was development of intimal hyperplasia, with fragmentation of medial elastic lamellae in the common carotid artery of the castrated rats. Orchidectomy induces adverse changes in structure of the common carotid artery of the male rat. These changes may impair vascular function, therefore constituting a possible structural basis for the higher incidences of cardiovascular diseases observed in hypogonadism.

Variant origin of the superior cerebellar artery in a black Kenyan population

Knowledge of variant origin of the superior cerebellar artery is important during neuroradiological and neurosurgical procedures at the basilar termination and clivus regions, and may influence the occurrence of atherosclerosis and aneurysms. These variations show ethnic differences, but there are hardly any reports on the black African population. This study therefore examined the various origins of 394 superior cerebellar arteries from 173 brains of black adult Kenyans, obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya. The cranial cavity was opened and the brain removed en bloc. Arachnoid matter was gently removed to expose the arteries at the base of the brain. The distal third of the basilar artery was exposed and superior cerebellar artery identified as that which supplied the superior surface of the cerebellar hemispheres. It was traced to its origin and the source recorded. Representative patterns were photographed with a high resolution digital camera. The data were analyzed for frequency and are presented in macrographs and a table. The conventional single artery origin from the basilar artery was present in only 284 (72.1%) cases. In the remainder, it was duplicated in 84 (21.3%), originated from posterior cerebral artery in 16 (4.0%) and from common trunk with posterior cerebral artery in 10 (2.5%) cases. Variant origin of the superior cerebellar artery occurred in nearly 28% of cases studied. This influences the pattern of termination of the basilar artery, may complicate posterior cranial fossa surgery and predispose to atherosclerosis and aneurysms. Preoperative evaluation of the superior cerebellar artery is recommended

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Features of atherosclerosis in the tunica adventitia of coronary and carotid arteries in a black kenyan population.

Introduction. Histologic changes which occur in the tunica adventitia during initiation, progression, and complications of atherosclerosis are seldom reported. This study aimed at describing the features of atherosclerosis in the tunica adventitia of two of the commonly afflicted arteries, namely, left anterior descending coronary and common carotid in black Kenyans. Materials and Methods. Specimens from 108 individuals [76 males and 32 females, mean age 34.6] were processed for paraffin embedding. Seven micron thick sections were stained with Mason's trichrome and Haematoxylin/Eosin and examined with a light microscope. Results. Features of atherosclerosis were present in the tunica adventitia of 14.8% of left anterior descending arteries and 11.1% of common carotid arteries. Increase in adventitial thickness was associated with increased density of vasa vasora in 8.3% of both arteries. In the left anterior descending and common carotid arteries, 6.5% and 3.7% of cases, respectively, the tunica adventitia thickened without intimal hyperplasia. Conclusion. Features of atherosclerosis occur in the tunica adventitia of coronary and carotid arteries in over 10% of the black Kenyans studied. These features often precede the intimo medial changes. Tunica adventitia should therefore be prioritized in evaluation for atherosclerosis, in individuals at risk. This may enhance early detection and intervention.

Variant termination of the left coronary artery: pentafurcation is not uncommon

Variant termination of the left coronary artery is important in interpreting effects of its occlusion, and in guiding cardiac surgery and intervention procedures. It also constitutes a geometric risk factor for atherosclerosis. These features show ethnic variations, but data from African populations are scarce. This study therefore aimed at describing the variant patterns of termination of the left coronary artery in an indigenous Kenyan population. Left coronary arteries of 208 formalin-fixed hearts were studied by dissection at the Department of Human Anatomy, University of Nairobi. The number of terminal branches was recorded. Images of representative patterns were taken using a high resolution camera. Frequencies were calculated. Results are presented using tables and macrographs. Single left coronary arteries from the left aortic sinus were present in all the 208 hearts studied. The most frequent termination pattern was bifurcation (54.8%), followed by trifurcation (32.2%), quadrifurcation (9.6%) and pentafurcation (3.4%). Over 45% of left coronary arteries have variant patterns of termination. Pentafurcation is not uncommon. This calls for extra caution during interventional coronary artery angiography, instrumentation and surgery. Preoperative angiographic evaluation is recommended

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Vertebral Artery Hypoplasia in a Black Kenyan Population.

This study examined the characteristics of vertebral artery hypoplasia in 346 arteries of adult black Kenyans. The circumference was measured on haematoxylin/eosin stained microscopic sections of the distal one-third of the intracranial vertebral arteries using scion image analyser. Internal diameter was calculated in millimetre. Data were analysed using SPSS version 16.0. Vertebral artery hypoplasia (diameter < 2.0 mm) occurred in 100 (28.9%) arteries. Sixty of these (17.3%) were on the left and 40 (11.6%) on the right. Sixty (17.3%) were in females while 40 (11.6%) were in males. The side and gender differences were statistically significant at confidence interval of 95%. Frequency of vertebral artery hypoplasia was higher than in most other populations studied. The condition differs from that in other populations because it is more common on the left side and in females. We recommend ultrasound, angio-CT, or angio-MRI evaluation of vertebral arterial system before diagnostic or interventional procedures on posterior circulation.

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.

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.