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Background: The rise in the use of motorcycles in Kenya in the last 10 years has been associated with increased injury rates. Between 2004 and 2009, motorcycle injuries increased at a rate of 29 % and, in some hospitals, motorcycle users have become the predominant road user category injured. Although most road traffic injuries occur in Nairobi, there has been no previous account of motorcycle injury and associated outcomes at its main hospital. Objective: To describe the injury patterns and outcomes following motorcycle trauma at the Kenyatta National Hospital. Methods: All motorcycle trauma admissions during one calendar year were analyzed. The data captured included demographics, injury patterns and outcomes, lengths of hospital stay, hospitalization cost, and early hospital mortality. Factors associated with outcomes were analyzed by univariate and multivariate means. The probability of survival was estimated using the Trauma and Injury Severity Score (TRISS) methodology for each patient. Results: Two hundred and five patients were reviewed. Motorcycle trauma admissions formed 22.3 % of all road traffic injury admissions. Male riders predominated. The average age and modal age group was 30.78 and 21-30 years, respectively. Half of riders and 20 % of passengers used protective helmets. Injuries were mostly to the extremities (60.7 %) and head/neck (32.07 %), and the average Injury Severity Score (ISS) was 7.57 + 4.0 (median 9.0). At 2 weeks, 9.0 % of patients had died. The estimated probability of survival ranged from 0.86 to 0.97. Surgical interventions were needed for 51.7 % of patients. The mean length of stay in the hospital was 24.3 days, while the cost of treatment was 31,783 Kenya Shillings (Kshs). Injury severity ( P < 0.001), admission to the intensive care unit (ICU) ( P < 0.001), non-surgical treatment ( P = 0.003), blood transfusion ( P = 0.029), head injury ( P < 0.001), and low Glasgow Coma Scale (GCS) score at admission were significantly associated with mortality. Conclusion: Injuries to the lower limbs and the head predominate in motorcycle trauma. The high mortality rate, need for surgery in the majority of patients, and prolonged admission days call for motorcycle control and expedited care. Significant head injury mortality calls for efforts to embrace helmet laws for riders and passengers. [ABSTRACT FROM AUTHOR]

Objective: In the developing world, data about the burden of injury, injury outcomes, and complications of care are limited. Hospital-based trauma registries are a data source that can help define this burden. Under the trauma care component of the Bloomberg Global Road Safety Partnership, trauma registries have been implemented at three sites in Kenya. We describe the challenges and lessons learned from this effort., Methods: A paper-based trauma surveillance form was developed, in collaboration with local hospital partners, to collect data on all trauma patients presenting for care. The form includes demographic information, pre-hospital care given, and patient care and clinical information necessary to calculate estimated injury surveillance. The type of data collected was standardized across all three sites. Frequent reviews of the data collection process, quality, and completeness, in addition to regular meetings and conference calls, have allowed us to optimize the process to improve efficiency and make corrective actions where required., Results: Trauma registries have been implemented in three hospitals in Kenya, with potential for expansion to other hospitals and facilities caring for injured patients. The process of establishing registries was associated with both general and site-specific challenges. Problems were identified in planning, data collection, entry processes, and analysis. Problems were addressed when identified, resulting in improved data quality., Conclusions: Trauma registries are a key data source for defining the burden of injury and developing quality improvement processes. Trauma registries were implemented at three sites in Kenya. Problems and challenges in data collection were identified and corrected. Through the registry data, gaps in care were identified and systemic changes made to improve the care of the injured., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Immediate trauma fatality is not amenable to trauma care and primary prevention is the key. The published profiles of deaths due to trauma differ in different regions. Injury mortality rates are higher in developing countries where injury data capture systems are unreliable for prevention purposes., Objective: To describe the pattern of pre-hospital injury (immediate) deaths at the Nairobi city mortuary and compare these with hospital (late) trauma deaths., Methods: Consecutive trauma autopsies performed over one year (November 2009 to December 2010) at the main mortuary of the Nairobi city council were analyzed for demographic (age, sex, occupation) characteristics, circumstances of the trauma and injury patterns. The patterns of injuries were compared to those of victims who survived and later died at the Kenyatta National Hospital over the same period., Results: Two hundred and thirty seven trauma autopsies were analyzed. The average age of the victims was 29.8 years (range 1-67 years). Christians (93.7%) and males (89.5%) predominated. The place of injury was the road in 32.9% and home/neighborhood in 57.5% of cases. The main mechanisms of fatal injury were traffic (35.4%), gunshot wounds (25.7%) and assault (19.8%). Burns and suicides accounted for 5.9% and 6.3% of fatalities. Most fatalities were intentional (59.4%) Of vehicular injuries, pedestrians predominated (65.5%). For assault, blunt and penetrating injuries accounted for 68.7% and 31.11% of fatalities. Law enforcement officers were responsible for majority of gunshot deaths. Fatal injuries were sustained in single, two and multiple regions in 56.2%, 25.7% and 14.2% of cases. The body region most involved was the head/neck (40.5%). Twelve children under 15 years died. Compared to in-hospital deaths, pre-hospital deaths were associated with intentional injuries, night-time occurrence and preponderance of gun involvement., Conclusion: Injury was a significant cause of mortality among adults of working age in this urban African setting. Intentional injuries predominate in causation of immediate but not late deaths. Local prevention programs should incorporate mortuary data to unravel further aspects of trauma and address violence as a key determinant of prehospital mortality., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Injury to the recurrent laryngeal nerve (RLN) is an important but avoidable complication of thyroidectomy. This complication may be avoided by the identification of the nerve facilitated by important landmarks found along its course. The setting for this work is the Human Anatomy Laboratory of the University of Nairobi. The aim of this work is to determine the topographic relationship of the RLN with the inferior thyroid artery (ITA), the tubercle of Zuckerkandl (TZ), and the ligament of Berry (LB) in a Kenyan population. The relationship between the nerve and the above landmarks was determined during dissection of 146 right and left thyroid lobes. One right side of the neck had a nonrecurrent nerve. Of the specimens where relationship was determined, the nerve was anterior to the ITA in 37% of cases and posterior in 51.4%. In relation to the LB, 45.3% were superficial (dorsolateral). The TZ was clearly delineated in 86 of the 146 specimens. No nerve traversed the tubercle. The RLN exhibited variations similar to those in other populations. The TZ when present was a reliable landmark to the nerve., (Copyright © 2011 Wiley-Liss, Inc.)

Objective: To investigate the uterine artery's origin, branching patterns, and relation to the ureter in a Kenyan population., Method: The uterine arteries of the bodies of 53 girls and women were dissected at the University of Nairobi Department of Human Anatomy to study these patterns. Data were analyzed for frequency and the patterns are presented via digital macrographs., Results: The uterine artery consistently originated as a branch of the internal iliac artery. It formed the second or third branch of the anterior trunk in 70.8% of cases; it ascended as a single branch, or from a bifurcation, or from a trifurcation in 76.4%, 17.1%, and 6.7% of cases; and lay posterior to the ureter in 3.8% of cases. In all, 46.2% of the uterine arteries studied varied from the classic description., Conclusion: About half of the uterine arteries had a nonclassic origin, branching pattern, or relation to the ureter-as a posterior relation to the ureter had not been previously described. Surgeons operating in the pelvis should be aware of this variant anatomy to avoid injury to the ureter and other organs., (Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: The functional significance of myocardial bridging remains controversial. The bridge morphology and structure of the tunneled vessels may modify its ultimate clinical effects., Objective: To describe the morphological characteristics of myocardial bridges and their influence on coronary histology., Design: A descriptive cross-sectional study., Methods: One hundred and nine formalin-fixed adult hearts were evaluated by dissection for these data: prevalence, site, lengths and depths of myocardial bridges. Vessel segments proximal and distal to the bridged portion were also processed for histology and stained to elaborate smooth muscle, collagen and elastic fibers. Stereology was also employed to compare the relative sizes of the tunica intima and the vessel wall to lumen ratios., Results: Myocardial bridges were found in 40.4% of the hearts, most commonly in the left anterior descending artery (LAD). The average length of the bridges was 22.66 +11.94 mm while the depth was 1.83+ 0.98mm, with only 11% being long (34.87mm - 50mm) and 9% of them being deep (3.46mm - 5.00mm). The tunica intima was thickest proximal to and thinnest under the myocardial bridge. The intima of the proximal segment was also more elastic. An elaborate perivascular 'cushion' of adipose tissue intervened between the intramural coronary and the surrounding myocardium., Conclusions: Most myocardial bridges are superficial and short. Tunica intima under myocardial bridges is spared from "atherogenesis". The thick perivascular space around the bridged segment may protect it from extreme compression.

Objective: To describe the pattern of gender-associated violence amongst adult survivors., Design: Descriptive case analysis of prospectively collected data., Setting: The gender violence and recovery centre (GVRC), a shelter and violence treatment facility for the gender-associated violence at the Nairobi Women's hospital (NWH)., Subjects: Data on 663 consecutive adult patients who presented to GVRC between February 2003 and April 2004 were evaluated., Results: The patients age ranged from 18 to 74 years (mean 27.7 years). Four hundred and eight patients (61.5%) presented following sexual assault. Most of assaults were perpetrated at night. A stranger was the assault perpetrator in 75.1% and 2% of sexual and non-sexual assault respectively. An intimate partner was the perpetrator in majority (86.5%) of nonsexual violence. Most physical injuries were minor bruises and swellings. The rate of positive spermatozoa from high vaginal swabs was only 15.9% in cases of sexual assault. Sexual assault was significantly associated with single status of the victim and assault by more than one assailant., Conclusions: Violence against women is a common public health problem in the city of Nairobi. Women are vulnerable both in and out of the home. More efforts, including massive public education, are needed to protect this vulnerable population.

Objective: To evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease., Design: Retrospective observational study., Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya., Subjects: Two hundred and fifty three tumours were categorised as right colonic (RCC), left colonic (LCC) and rectal (RC) lesions. The distribution of symptoms (rectal bleeding, tenesmus, change in bowel habits, abdominal pain, intestinal obstruction, rectal mass), anaemia, transfusion requirement, and the Dukes' stages were compared for right colon, left colon and rectal tumours., Results: There were 54 RCC, 59 LCC, 140 RC lesions. Patient delay from onset of symptom(s) to presentation was a mean of 26.6 +/- 43, 20 +/- 25 and 33.7 +/- 42 weeks for right, left and rectal lesions respectively (p = 0.092). The proportion of patients presenting with rectal bleeding was 21%, 44% and 79% for RCC, LCC and RC lesions, respectively. The prevalence of intestinal obstruction was 14.8%, 27.1% and 43.6% in right, left and rectal lesions, respectively. The haemoglobin levels were significantly lower for right sided lesions (p = 0.05 for right colon/rectum pair; p = 0.059 for right colon/left colon pair). The sites of the lesions had no relationship to the stage of disease at presentation., Conclusion: In patients with colorectal cancer, the duration of symptoms was prolonged irrespective of the anatomical sub-sites. Symptoms were evenly distributed across the anatomical regions except for bleeding and obstruction which predominated in rectal and left colon cancers respectively. This underlines the need for early investigations in patients with rectal bleeding, change of bowel habit, intestinal obstruction and anaemia.

Objective: To describe the topography and anatomical variations of the carotid arteries among Kenyans., Design: A descriptive cross-sectional study., Setting: Department of Human Anatomy, University of Nairobi., Subjects: Eighty carotid arteries of forty cadavers were dissected., Results: The bifurcation of the commonest carotid artery was high (above the reference points) in 63.8% of vessels and the external carotid was antero-lateral to the internal carotid artery in 30% of the vessels. A linguo-facial trunk was the most common variation of the external carotid artery. The origin of the right common carotid artery was high and low in 10% and 2.6% of vessels respectively., Conclusion: The carotid arteries show important variability and thus emphasise caution for clinicians during surgical procedures in the neck.

Kenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Women's Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were < or =5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.

Background: CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce., Objective: The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes for two time periods., Setting: The setting was Kenyatta National Hospital (KNH), a teaching and referral center., Patients and Methods: A total of 259 patients seen over two time periods (1993-1998 and 1999-2005) were analyzed for admission date, sex, subsite involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods were analyzed using Student's t-test and chi2 as appropriate. Survival trends were generated using Kaplan Meier method; p<0.05 was statistically significant., Results: The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was 49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer, advanced disease, age>50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of patients<40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis, less in-hospital mortality, and better staging data., Conclusion: CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance, and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy., (2007 Wiley-Liss, Inc)

Objective: To describe the emergency care of injuries at a main city hospital., Design: A prospective study., Setting: Data were collected between February 1st, 1999 and 30th April, 1999 from the records of the 2000 bed Kenyatta National Hospital (KNH) in Nairobi, Kenya., Subjects: Two hundred and forty injury patients admitted at KNH were analysed., Methods: All patients were analysed for demographics, environment of injury hospital arrival and Emergency Department times. The effects of injury severity, place of injury and time of day on these time intervals were analysed statistically., Results: Road injury admissions formed 31% of all injury admissions. The mean age was 30 years. Males comprised 84.6% of all patients. The proportions of patients under 20 years of age was 20% with a peak age of 20-29 years. Majority (43.3%) of the injured resided in deprived neighbourhood of East Nairobi. The mean pre-hospital time was 2.56 hours. The Emergency Department disposition time was 3.36 hours. Injuries of all severities, as determined by the Injury Severity Score (ISS), were treated. The pace of care did not match severity of the injuries. Only 17.5% reached their areas of definitive care within sixty minutes., Conclusion: Injuries following road traffic accidents (RTAs) are common in Nairobi. The response to injury is slow and haphazard. The insitution of a care incorporating the city's health centers and pre-hospital triage may optimise care.

Objective: To determine the pattern of coronary arterial anatomy and prevalence of postmortem coronary pathology in adult Kenyan Africans., Design: Cross-sectional study., Setting: The Nairobi City Mortuary and the Department of Human Anatomy, University of Nairobi., Method: One hundred hearts were retrieved during consecutive autopsies over a three month duration and systematically dissected. Details on coronary ramification, dominance, atherosclerosis, tunnelling and hypoplastic segments were obtained and statistically analysed., Results: Seven patterns of left coronary ramifications were identified. The right coronary artery anomalously exited from the left coronary sinus in one situation. There were separate ostia for the coronary artery branches in 2% and 31 % of cases on the left and right coronary systems respectively. The right coronary artery was dominant in 82% of the hearts. Coronary ostial sizes and luminal dimensions showed wide variations. Only two of the hearts had atheromatous luminal narrowing greater than 75% of the cross-sectional area. Muscle bridges of average depths of 1.1-2 mm were demonstrable in 29% of the autopsies. Diminutive left anterior descending artery was present in four cases. The right coronary artery was diminutive in one case., Conclusion: Coronary atherosclerosis is still a rarity in the setting within which the study was undertaken. The diverse patterns of ramifications of the coronary tree begs for caution during coronary investigations and interventional procedures. Coronary arterial anomalies, myocardial bridges, atheroma and diminutive arteries should be considered in cases of sudden cardiac death in the absence of other pathologies.

Objective: To evaluate the clinical and epidemiological data on automobile injuries and to assess the adequacy of road trauma documentation at the Nairobi Hospital., Design: A retrospective descriptive study., Setting: The Accident and Emergency Centre of the Nairobi Hospital., Subjects and Method: Medical records of randomly selected road trauma patients who presented at The Accident Centre between 1st July 1997 and 31st August 1998 were analysed., Results: The mean age was 32 years with a peak incidence in the 21-30 year age group. Males comprised 63.1% of the injured. The predominant category of the road user injured was the vehicle occupant (70%). Pedestrians only constituted 21.3%. Major city roads or highways were the commonest scenes of injury (38.3%). Most of the responsible vehicles were small personal cars (65.8%). The public service minibuses (popularly known as matatu) caused 20% of the injuries. Most of the injuries were mild and transport of the injured to hospital was uniformly haphazard. A quarter of the injuries were severe enough to warrant admission. Trauma documentation was poor with less than 30% accuracy in most parameters., Conclusion: The pre-hospital and initial care of the injured is not systematized. The study calls for re-orientation of trauma care departments to the care of the injured.