SummaryBackgroundIn sub-Saharan Africa, severely immunocompromised HIV-infected individuals have a high risk of mortality during the first few months after starting antiretroviral therapy (ART). We hypothesise that universally providing ready-to-use supplementary food (RUSF) would increase early weight gain, thereby reducing early mortality compared with current guidelines recommending ready-to-use therapeutic food (RUTF) for severely malnourished individuals only.MethodsWe did a 2 × 2 × 2 factorial, open-label, parallel-group trial at inpatient and outpatient facilities in eight urban or periurban regional hospitals in Kenya, Malawi, Uganda, and Zimbabwe. Eligible participants were ART-naive adults and children aged at least 5 years with confirmed HIV infection and a CD4 cell count of fewer than 100 cells per μL, who were initiating ART at the facilities. We randomly assigned participants (1:1) to initiate ART either with (RUSF) or without (no-RUSF) 12 weeks' of peanut-based RUSF containing 1000 kcal per day and micronutrients, given as two 92 g packets per day for adults and one packet (500 kcal per day) for children aged 5–12 years, regardless of nutritional status. In both groups, individuals received supplementation with RUTF only when severely malnourished (ie, body-mass index [BMI] <16–18 kg/m2 or BMI-for-age Z scores <–3 for children). We did the randomisation with computer-generated, sequentially numbered tables with different block sizes incorporated within an online database. Randomisation was stratified by centre, age, and two other factorial randomisations, to 12 week adjunctive raltegravir and enhanced anti-infection prophylaxis (reported elsewhere). Clinic visits were scheduled at weeks 2, 4, 8, 12, 18, 24, 36, and 48, and included nurse assessment of vital status and symptoms and dispensing of all medication including ART and RUSF. The primary outcome was mortality at week 24, analysed by intention to treat. Secondary outcomes included absolute changes in weight, BMI, and mid-upper-arm circumference (MUAC). Safety was analysed in all randomly assigned participants. Follow-up was 48 weeks. This trial is registered with ClinicalTrials.gov (NCT01825031) and the ISRCTN registry (43622374).FindingsBetween June 18, 2013, and April 10, 2015, we randomly assigned 1805 participants to treatment: 897 to RUSF and 908 to no-RUSF. 56 (3%) were lost-to-follow-up. 96 (10·9%, 95% CI 9·0–13·1) participants allocated to RUSF and 92 (10·3%, 8·5–12·5) to no-RUSF died within 24 weeks (hazard ratio 1·05, 95% CI 0·79–1·40; log-rank p=0·75), with no evidence of interaction with the other randomisations (both p>0·7). Through 48 weeks, adults and adolescents aged 13 years and older in the RUSF group had significantly greater gains in weight, BMI, and MUAC than the no-RUSF group (p=0·004, 0·004, and 0·03, respectively). The most common type of serious adverse event was specific infections, occurring in 90 (10%) of 897 participants assigned RUSF and 87 (10%) of 908 assigned no-RUSF. By week 48, 205 participants had serious a...
Since the 1960s, East African athletes, mainly from Kenya and Ethiopia, have dominated long-distance running events in both the male and female categories. Further demographic studies have shown that two ethnic groups are overrepresented among elite endurance runners in each of these countries: the Kalenjin, from Kenya, and the Oromo, from Ethiopia, raising the possibility that this dominance results from genetic or/and cultural factors. However, looking at the life history of these athletes or at loci previously associated with endurance athletic performance, no compelling explanation has emerged. Here, we used a population approach to identify peaks of genetic differentiation for these two ethnicities and compared the list of genes close to these regions with a list, manually curated by us, of genes that have been associated with traits possibly relevant to endurance running in GWAS studies, and found a significant enrichment in both populations (Kalenjin, P = 0.048, and Oromo, P = 1.6x10-5). Those traits are mainly related to anthropometry, circulatory and respiratory systems, energy metabolism, and calcium homeostasis. Our results reinforce the notion that endurance running is a systemic activity with a complex genetic architecture, and indicate new candidate genes for future studies. Finally, we argue that a deterministic relationship between genetics and sports must be avoided, as it is both scientifically incorrect and prone to reinforcing population (racial) stereotyping.
Background: Anatomical variations of the human body including the extra hepatic biliary system exist across various individuals. Understanding the variant anatomy of the extrahepatic biliary system aids surgeons in avoiding iatrogenic injuries. This is important in resource limited settings where it is not possible to perform adequate radiological investigations of the hepatobiliary system prior to surgery. This study described the anatomic variation of the extrahepatic biliary system among Kenyans. Methods: This was a cross-sectional study conducted at Moi University Anatomy Laboratories among 42 adult cadaveric specimens. Specimen dissections were conducted as per the fifteenth edition of Cunningham manual of Practical Anatomy. The variant anatomy data collected were filled in a structured data collection form, analyzed and presented using descriptive statistics. Study Findings: Of the 42 cadavers sampled, 62% (n=26) were male while 38% (n=16) were female. All had a gall bladder being drained by the cystic duct. The length of the cystic duct ranged between 7-35 mm joining the common hepatic duct to form the common bile duct in 98% (n=41) of all the cadavers sampled. This confluence was to the left in 7.1% (n=3), right 42.9% (n=18), anteriorly in 14.3% (n=6) and posteriorly 35.7% (n=14). A single cadaver (2%) had the cystic duct drain into the right hepatic duct. Two thirds (66.7%; n=28) of the cadavers sampled had the confluence of the right and the left hepatic duct outside the liver. There were no cholecystohepatic ducts in this study. Conclusion: The study determined the existence of surgically important variant anatomy of the extrahepatic biliary system. There is need for greater appreciation of the extrahepatic biliary system variant anatomy by both surgeons and radiologists so as to decrease morbidity and improve on surgical outcomes.
Purpose: To assess the preparedness of public health care facilities in the provision of breast and cervical cancer services. Specifically, healthcare providers knowledge on risk factors, screening, symptoms, diagnosis and treatment as well as availability of medical equipment required for breast and cervical cancer management. Methods: A cross-sectional service provision assessment (SPA) survey conducted in Busia and Trans-Nzoia counties of Western Kenya between October and December 2018. Interviewer assisted questionnaires were used to collect data from healthcare workers while a structured facility questionnaire was used to assess the level of preparedness of the selected public healthcare facilities stratified by their level of care. Statistical analysis was done using STATA version 15. Results: We enrolled 73 healthcare workers 37 (50.6%) of whom were nurses, followed by clinical officers and medical officers. The highest proportion of knowledge on risk factors and screening of breast and cervical cancer was reported among medical officers or consultant physicians, followed by clinical officers. Nurses scored highly on the symptoms of breast and cervical cancer. The medical equipment required for breast and cervical cancer screening and diagnosis were found in most facilities; however, there were no core-biopsy needles or mammograms found. A single LEEP equipment was found in a health center within Trans Nzoia while two LEEP equipment were stationed at the Busia county hospital. Conclusion: A below average level of knowledge on breast and cervical cancer among the healthcare workers attending to patients in public healthcare facilities was found in both Busia and Trans Nzoia counties. Furthermore, there was a disparity in the distribution and quantity of priority medical equipment for the screening, diagnosis and treatment of breast and cervical cancer in the two county hospitals.
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