Zoology

Histidine rich protein ii and lactate dehydrogenase levels in saliva and blood in acute malaria cases in Kisumu, western Kenya

2024-01-01T00:00:00Z

Histidine rich protein ii and lactate dehydrogenase levels in saliva and blood in acute malaria cases in Kisumu, western Kenya AWUOR, Ruth Omingo Globally, malaria is the leading cause of death and economic burden. Diagnosis currently relies on microscopy and blood-based rapid diagnostic tests (RDTs). However, both methods are invasive, which increases the risk of accidental infection and is painful. Non-invasive approaches are thus required. Plasmodium falciparum Histidine Rich Protein-2 (Pf.HRP-2) and Plasmodium falciparum Lactate Dehydrogenase (Pf.LDH) are parasite enzymes released into the host blood during clinical malaria infection and have been demonstrated in saliva though with inconsistent results. This may be because most of these studies have been performed in low malaria endemic zone. This study seeks to determine the levels of these antigens in blood and saliva in a high malaria endemic zone and determine their relationship with parasite density. On the other hand, the performance of blood-based RDTs is dependent on parasite density, which in turn decreases with age. The present study determined the performance and efficiency of detection of P. falciparum antigens levels in saliva and blood as potential biomarkers in the diagnosis of malaria infection using blood-based RDT and saliva-based ELISA assay across ages. Specifically, the study determined the relationship between levels of P. falciparum antigens in saliva and blood, and parasite densities, clinical malaria and age in individuals of varying ages with acute malaria: The correlation between the antigen levels in blood and saliva and the sensitivity, specificity, positive and negative predictive values for detection of P. falciparum antigens. This was a cross- sectional study involving participants presenting with clinical malaria at Chulaimbo Sub- County hospital. Levels of P. falciparum antigens in saliva and blood were measured using ELISA. Generalized linear model was done to assess the relationship between the levels of P. falciparum antigens to parasite densities, clinical malaria and age. Correlation between levels of Pf. HRP-2 and Pf.LDH in blood and saliva were evaluated using Pearson’s correlation. Sensitivity/specificity of the blood-based rapid diagnostic tests as well as blood and saliva-based Elisa assay were calculated. Parasite density did not predict Pf.HRP-2 in plasma and saliva (p=0.974) and (p=0.635) respectively. Also, parasite density did not predict Pf.LDH in plasma and saliva (p=0.570) and (p=0.315) respectively. In addition, clinical malaria did not predict Pf.HRP-2 in plasma and saliva (p=0.179) and (p=0.895) respectively. Equally, clinical malaria did not predict Pf.LDH in plasma and saliva (p=0.291) and (p=0.272) respectively. In contrast, age significantly predicted Pf.HRP-2 levels in plasma (p=0.00) but not in saliva (p=0.580). On the other hand, age did not significantly predict Pf.LDH levels in both plasma and saliva (p=0.406) and (p=0.764) respectively. Moreover, there was no significant relationship in the levels of Pf.HRP-2 and Pf.LDH in plasma and saliva (r=-0.235, p=0.104) and (r=-0.0235, p=0.104) respectively. Sensitivity of detection using blood-based RDTs in children and adults was found to be (98%) and (100%) respectively. Specificity was (28%) in children and (83%) in adults. Sensitivity of Pf.HRP-2 detection in children by ELISA was 78% in plasma and 13% in saliva. Pf.LDH in children was detected at a sensitivity of 15% in plasma and 7% in the saliva. In adults, Pf.HRP-2 had a sensitivity of 75% in plasma and 50% in saliva. Specificity of Pf.HRP-2 was 40% in plasma and 95% in saliva of children. Pf.LDH was detected at 100% specificity in both plasma and saliva of children and adults. Measurement of Pf.HRP-2 and Pf.LDH in plasma and saliva may not be a good proxy measure of infection and clinical disease in populations exposed to endemic malaria, However, Pf.HRP-2 can be used to measure cumulative exposure. Measurement of Pf.HRP-2 and Pf.LDH in saliva cannot substitute for the measurement in plasma hence plasma-based assays are more reliable. The lower sensitivity of Pf.HRP-2 in both plasma and saliva in holoendemic areas may not be improved using saliva samples prompting the need for further research. Master's Thesis

Comparison of microscopy and real-time pcr in diagnosis of snail schistosoma infection in river Asao, Kisumu county, western Kenya

2024-01-01T00:00:00Z

Comparison of microscopy and real-time pcr in diagnosis of snail schistosoma infection in river Asao, Kisumu county, western Kenya Schistosomiasis is the third most devastating parasitic infection of the genus Schistosoma. It causes about 200 million deaths globally per annum which is passed by infected intermediate snail hosts of the genus Biomphalaria and Bulinus. Western Kenya is among the endemic regions in Kenya with a high prevalence of the disease. The disease control is mainly based on mass drug administration of praziquantel to the final host, with little attention paid to the role of snail intermediate host on the prevalence and transmission of schistosomiasis. Specifically, there is limited data on the species diversity of snails, distribution and parasite infection rates of snails, in inland waters flowing to Lake Victoria. Additionally, less sensitive approaches such as microscopy have mostly been used in studies related to the intermediate hosts, Bulinus and Biomphalaria snails. Therefore, this study aimed to determine: the distribution of the intermediate host snails along River Asao; prevalence of infection in intermediate host snails among the sampling sites; the correlation between the effectiveness of microscopy and advanced molecular tools such as the real-time PCR (RT PCR) in detection and quantification of the parasitic load among infected snails and finally, to quantify infection in snails as the parasite multiplies within the snails and off-host miracidia quantification. The methods involved sampling of snails from sampling sites along river Asao. A GPS visualizer tool was used to map the location of the intermediate snail hosts and focal points of infection. The locations of the snails collected was recorded and used to map the distribution of both infected and uninfected snails following screening in the lab. The snails were then identified morphologically using identification keys as well and standard Polymerase Chain Reaction technique. The parasite load of infected snails was determined by use of microscopy through counting of cercariae shed and by real-time PCR through quantification of the parasite DNA present in the snail host. Only Biomphalaria pfeifferi and Bulinus globosus were present in river Asao. Biomphalaria snails were evenly distributed, while Bulinus snails were focally distributed. Microscopy detected 16% infected Bulinus and 2% infected Biomphalaria snails while real-time PCR detected 28% and 17% infected snails of the Bulinus and Biomphalaria species, respectively. Microscopy-positive snails also tested positive for real-time PCR. There was no correlation between the cercariae number by microscopy and RT-PCR (r= -0.261, P= 0.438) and also between miracidia number by microscopy and RT-PCR value (r = -0.312, P = 0.192). However, an increase in number of Schistosoma sporocysts inside infected snails was significantly shown by real-time PCR ((χ² = 14.18, df = 4, P = 0.0067). Microscopy is suitable for quantification of Schistosoma cercariae and miracidia by counting but is not as sensitive as real-time PCR in the detection of infected snails. Real-time PCR is a useful tool for quick results when identifying and quantifying infected snails in a certain region and thus easy to carry out proper control measures to prevent disease transmission and snail breeding. The infection distribution map can be used to raise awareness of active transmission sites to lower chances of the disease transmission. Master's Thesis

Evaluation of Plasmodium Falciparum Resistance to Sulfadoxine- Pyrimethamine in Human Immunodeficiency Virus(HIV) Infected and Non-Infected Pregnant Women in A Malaria-Endemic Region of Western Kenya

2012-01-01T00:00:00Z

Evaluation of Plasmodium Falciparum Resistance to Sulfadoxine- Pyrimethamine in Human Immunodeficiency Virus(HIV) Infected and Non-Infected Pregnant Women in A Malaria-Endemic Region of Western Kenya SHILULI, Clement Likhovole Malaria and Human immunodeficiency virus (HIV) co-infection in pregnancy is a major cause of anaemia, low birth weight (LBW) abortion and infant mortality in malaria-endemic countries of sub-Saharan Africa. Intermittent preventive therapy (IPTp) with Sulfadoxinepyrimethamine (SP) is recommended by the World Health Organization ((WHO) for malaria control during pregnancy. However, widespread resistance of Plasmodium falciparum to SP is a threat to the IPTp strategy. Therefore, there is an urgent need to evaluate the extent of parasite resistance to SP, specifically in pregnant women. The overall objective of this study was to evaluate P. falciparum resistance to SP in HIV -infected and non-infected pregnant women using real-time PCR. Samples used in this study were obtained from 94 women enrolled in a retrospective study conducted in Siaya and Bondo district hospitals in western Kenya, to investigate the effectiveness of daily cotrimoxazole (CTX) in preventing malaria during pregnancy. The enrolled women were categorized into four treatment arms on the basis of the drug used during pregnancy: SP, cotrimoxazole (CTX), SP and CTX and neither SP nor CTX. After delivery, peripheral and placental blood was collected and thick and thin smears made and stained with 10% Giemsa stain for P. Jalciparum detection using a light microscope. Unigold" and Determine" rapid tests were used for HIV testing. Parasite-positive peripheral and placental dried blood spots, obtained at delivery, were analyzed for the presence of specific mutations in the P. Jalciparum dihydrofolate reductase (Pf/dhfr) and dihydropteorate synthase (Pjldhps) genes associated with SP resistance using real-time PCR. Prevalence and profiles of . Pf/dhfr and Pjldhps mutations were compared using the chi-square test cl, PSO.050). Overall, there was high prevalence (>50%) of Pjldhfr and Pjldhps mutant codons (Pjldhfrl08N, 511, 59R, and Pjldhps 437G, 540E) in both peripheral and placental samples in all treatment arms. There was no significant difference in the profiles of Pjldhfr (SP, P=0.934; CTX, P=O.l89; SP and CTX, P=0.407; neither SP nor CTX, P=0.477) and Pf/dhps (SP, P=0.655; CTX, P=0.705; SP and CT., P=0.513; neither SP nor CTX, P=0.646) mutant codons between peripheral and placental samples. The prevalence of the quintuple mutant (Pjldhfr Asn-l08/1le-511Arg- 591Pjldhps Gly-437/Glu-540) associated with in vivo SP treatment failure was high in all the treatment arms (>50%) and was comparable in both peripheral and placental samples in the different arms (SP, P=0.350; CTX, P=0.083; SP and CTX, P=l.OOO; neither SP nor CTX, P=0.362). However, in HIV -positive women in the CTX treatment arm, the prevalence of the quintuple mutant was significantly higher in placental samples (90.9%) than in peripheral samples (50%) (P=0.033). This study revealed that there is very high prevalence of PjldhJr and Pjldhps resistance markers. Therefore, there is need for in vivo trials to evaluate SP efficacy in pregnant women in western Kenya. In addition, these findings can inform the design of field surveillance and monitoring of SP resistance in pregnant women resident in malaria-endemic regions,

Estimation of Trophic State Indices And Phytoplankton Quotients in Kisumu Bay, Nyanza Gulf, Lake Victoria

2012-01-01T00:00:00Z

Estimation of Trophic State Indices And Phytoplankton Quotients in Kisumu Bay, Nyanza Gulf, Lake Victoria MISIKO, Florence Monicah Kisumu Bay is greatly impacted by pollution from anthropogenic activities around Nyanza Gulf and from increasing levels of industrial and municipal waste discharges \ from Kisumu City. This has resulted in significant changes; in the level of eutrophication and the general ecology of the bay, impacting negatively on water quality, biodiversity, fisheries and livelihoods. These changes need to be monitored constantly for the effective environmental management of the gulf. The level of eutrophication of the Kisumu Bay has, however, not been determined. This study aimed at estimating the Trophic State Indices and Phytoplankton Quotients, 'as key indicators of eutropbication, in Kisumu Bay, and to determine the level of eutrophication of Kisumu Bay. Water quality measurements were conducted from April 2009 to March 2010. Physico-chemical parameters including Secchi depth was determined with a Secchi disc, turbidity,' temperature, conductivity, alkalinity and dissolved oxygen concentration were measured in situ using a seabird multi-parameter water quality probe, whereas nutrients levels (ammonia, nitrates, nitrite, total nitrogen, soluble reactive phosphorus, total phosphorus and chlorophyll a) and phytoplankton analyses were done by spectrophotometric and microscopic techniques, respectively. There were significant spatial differences in the dissolved oxygen concentrations (ANOVA, p< 0.01) within the bay. These differences were highly pronounced at the Kisat, Maboko and Yacht Club stations which are associated with sewage discharges from Kisumu City. Significant differences (ANOVA, p < 0.05) associated with discharges from Kisumu City and seasonal nutrient runoffs from storm water were also observed in the spatial and temporal distribution of phosphorous, ammonia, nitrates, nitrites and silicates within the bay. Significantly higher (ANOVA, p

Immunization Studies in Rabbits Using Midgut Membrane Bound Protein Derived from rhipicephalus Appendiculatus Neumann, rhipicephalus Rvertsi evertsiNeumann and Amblyomma variegatum fabricius

1990-01-01T00:00:00Z

Immunization Studies in Rabbits Using Midgut Membrane Bound Protein Derived from rhipicephalus Appendiculatus Neumann, rhipicephalus Rvertsi evertsiNeumann and Amblyomma variegatum fabricius KUTIMA, Hellen Lydia The objective of this study was to immunize rabbits with midgut membrane-bound proteins derived from partially engorged Rhipicephalus appendiculatus, ~. evertsi evertsi and Amblyomma variegatum female ticks a~d assess whether the immunity elicited was protective against both homologous and heterologous tick ins tars and to isolate and identify the protective antigens. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of the Gut Membrane-Bound Protein (GMBP) antigens demonstrated protein bands with molecular weights ranging from 14 to 140 kDa. Approximately 37 protein bands were fractionated from ~. appendiculatus GMBP antigens, approximately 45 protein bands ere fractionated from . evertsi evertsi GMBP antigens and approxi ately 39 protein bands were fractionated from !. variegatum GMBP antigens. Twentytwo of the isolated proteins were shared among the three tick species. The ability of rabbits to acquire resistance 'to ~. appendiculatus, R. evertsi evertsi and !. variegatum was determined by injecting three separate se~s of rabbits with respective GMBP antigens. Resistance was manifested by prolonged feeding, reduction in engorgement weights, egg mass weights, mou ting and percentage hatchability and increa ed xvii mortality. Cross-resistance was evaluated by dividing !. appendiculatus, !. evertsi evertsi and !. variegatum resistant rabbits into three groups each and challenging them with homologous and heterologous live stages. Considerably high cross-resistance was apparent among the three groups. Cross-protection was more pronounced in the homologous than heterologous systems. Enzyme Linked Immunosorbent Assay. (ELISA) technique detected circulating antibodies in the immune sera to GMBP from homologous and heterologous systems one week after the primary dose. Ouchterlony double immunodiffusion reactions with anti-tick GMBP sera formed 2 to 4 precipitin lines with homologous GMBP antigens and 1 to 2 precipitin line(s) with each heterologous GMBP antigens. A line of complete identity was observed when immune sera to GMBP antigens reacted with GMBP from homologous and heterologous tick species, suggesting common antigenic epitopes. Western blot analysis on GMBP of R. appendiculatus, !. evertsi evertsi and !. variegatum with sera from immunized rabbits detected protein bands specific to the homologous GMBP antigens, and revealed considerable cross-reactions in the heterologous systems. In conclusion, there was prolonged feeding periods, reduced engorged weights, egg mass weights XVlll hatchability and moulting and increased death rate of both homologous and heterologous challenge ticks which fed on resistant rabbits. This was due to the presence of common antigens. The presence of cross-reacting antigens conferred cross-protection. These results have pointed out that it is possible to protect livestock from R. appendiculatus, !. evertsi evertsi and !. variegatum using an antigen from anyone of the three tick species hence reducing the expence of having to develop an antigen to control each tick species as there are in existence.

Effects of rice-fish integration on the Productivity of irrigated paddies in east Kano Irrigation scheme, western Kenya

2013-01-01T00:00:00Z

Effects of rice-fish integration on the Productivity of irrigated paddies in east Kano Irrigation scheme, western Kenya BOLO, .Z. Japheth Otieno Rice-fish integration is practiced in many places in the world with varied success. Carps, milkfish and tilapias are traditionally used. One other potential fish, particularly for Africa, is the African catfish tClarias gariepinusi. Whereas adoption of rice-fish integration technology would potentially increase aquaculture fish production in Kenya, local trials have not adequately been undertaken resulting in knowledge gaps including number of fish species involved under integration and the yields of both fish and rice, that this study sought to bridge. The present study integrated Basmat rice variety with African Catfish (Clarias gariepinus) and Nile tilapia (Oreochromis niloticus) at Ahero Rice Research Station in Western Kenya (.0°08' Sand 34°56' E) with a view to assessing the viability of such integration in Western Kenya. Three treatments with varying fish stocking densities were tested in triplicate - rice-catfish low density (4 fish/m"), rice-catfish high density (8 fish/m") and rice-catfish-tilapia polyculture (4 fish/m ' per species). The paddies were fertilized but no suppiementary feeding was done to the fish in all the treatments. After a 122days ' trial, the mean weight of catfish had increased from the initial weight of 16.6±0.2g to 136±11.2g in RCH, 16.0±0.lg to ISO.3±6.4g in RCL and 16.2±0.4g to IS6.9±9.09g in RCT. For tilapia mean weight had increased from the initial of 10.0±0.lg to IOS.4±7.0Sg. The catfish yields were 373.16 kg/ha in the RCT, 288.88 kg/ha in RCH and 236.26 kg/ha in RCL. Catfish grown under RCL recorded lowest growth rates, which was significantly different (ANOY A; p O.OS). This study demonstrated highest productivity with rice-fish polyculture integration, giving highest yields for both the fish species - catfish and tilapia, and rice. Although carried out in a new environment, these findings showed potential for success and are suggested for up-scaling and adoption in East Kano. The impact of giving supplementary feeds to fish in a rice-fish polyculture integrated system is recommended for further investigation.

Acquired plasmodium falciparum-specific antibody responses are associated with efficacy to artemisinin-based combination therapy (act) in the treatment of uncomplicated malaria in Kombewa, western, Kenya

2018-01-01T00:00:00Z

Acquired plasmodium falciparum-specific antibody responses are associated with efficacy to artemisinin-based combination therapy (act) in the treatment of uncomplicated malaria in Kombewa, western, Kenya OYUGI, Geoffrey Odhiambo Significant advancement achieved in the chemoprophylaxis and chemotherapy of malaria has been pivotal for eventual reduction of malaria prevalence. However, a major setback has been the emergence of resistance to antimalarial drugs. Towards the goal of curbing emergence of resistance, artemisinin-based combination therapies (ACT), is now adopted by many countries as the first-line treatment for malaria. The recently reported cases of resistance to ACT in South East Asia (SEA), have raised concerns on future of ACT. Therefore, an urgent need exists to fully understand the molecular determinants of ACT efficacy. This study aims to determine the baseline magnitude and breadth of antibody responses and also to associate the antibody responses to efficacy of ACT. We hypothesize that in Kombewa-western Kenya, a holoendemic region, pre-existing antibody responses to specific P. falciparum antigens is a predictive correlate of ACT efficacy in patients with uncomplicated malaria. There has been reported delay in parasite clearance following artemisinin treatment in Kenyan and resurgence of parasite prevalence and malaria vector in Kombewa recently. This sub-study was conducted as part of the larger two-arm (Artesunate-Mefloquine (ASMQ) and Artemether Lumefantrine (AL) randomized, open-label trial. Baseline sera from 82 patients (AL=40,ASMQ=42) enrolled in the arms of the trial were analyzed for total IgG against erythrocytic (Apical membrane Antigen-1 (HB3and 3D7 strains), Merozoite surface protein -1(3D7 and FVO strains) and pre-erythrocytic stage (Liver Stage Antigen , Cell-traversal for Ookinetes and sporozoites and Circumsporozoite protein ) P. falciparum antigens using Luminex. Since ACT efficacy can be assessed based on parasite clearance rate, patients were grouped into fast clearers and faster clearers, using parasite clearance half-life (PC1/2).The threshold was fixed at the 25th percentile which was 2.02 hours. Variables were compared using Mann-whitney U test, χ2 test and z test as appropriate to examine associations between immunological endpoints and clinical endpoints. Patients generally had high prevalence of IgG antibodies (91-100%) and those >5 years of age had significantly higher titers of anti-AMA1HB3-specific antibodies (p=0.0316) than those <5 years. Faster clearers had levels of AMA1HB3-specific antibodies significantly higher (p=0.0065) than fast clearers. This association was significant even when ASMQ subjects were analyzed (p=0.0073). However, in AL arm anti-LSA-1 antibodies were significantly higher in faster clearers. This finding suggests that specific IgG antibodies againstAMA1-HB3 and LSA-1, observed in this setting, could be predictive of ACT efficacy and could therefore be used in surveillance for resistance (delayed clearance). This result should be confirmed in a large-scale study. Masters Thesis

Evaluation of Point-Of-Care Test for Early Infant Diagnosis and Viral Load Monitoring of Hiv-1 Infection in Western Kenya

2015-01-01T00:00:00Z

Evaluation of Point-Of-Care Test for Early Infant Diagnosis and Viral Load Monitoring of Hiv-1 Infection in Western Kenya OUMA, Kenneth Ndiege In developing countries with disproportionately high burden of HIV-1 (HIV) infections, access to early infant diagnosis (EID) and viral load (VL) HIV nucleic acid testing is limited by the prohibitive infrastructural costs of centralized testing laboratories. To increase access to HIVEID and VL monitoring, development of robust and low cost point of care (POC) technologies is a priority of current HIV diagnostic research. In Kenya, a number of POC technologies are being evaluated for EID and VL. One such POC technology is the simple amplification based assay (SAMBA) which is most advanced in its validation for use in a number of countries. However, in Western Kenya, with highest HIV prevalence, and possibly a wide range of HIV subtypes and recombinant forms, the performance of SAMBA has not been determined. The objective of the study was to evaluate the laboratory performance indices of SAMBA on HIV EID and VL testing. The study was cross sectional conducted in patient support facilities in 6 counties within Western Kenya region (namely Siaya, Nyamira, Kisii, Kisumu, Migori and Homabay counties). Male and female participants were recruited into the study and were distributed as follows: Infants aged <18 months (n=335) and adults aged >18 years (n=200). Patients were randomly recruited from the six counties. Whole blood from infants and plasma (separated at the facilities) from adults were collected from the facilities and shipped to the KEMRI/CDC Kisian testing laboratory. Whole blood were tested on SAMBA-qualitative (SAMBA-Q) assay for EID and plasma on SAMBA-semi-quantitative assay (SAMBA-SQ) for VL. All specimens were tested in parallel on the reference standard of care CobasAmpliprep/Taqman (CAP/CTM) assay. Specimens (n=11) with discordant results were further analyzed on Abbott m2000 as a tie breaker. In addition, total RNA was extracted from the discordant specimens, HIV pol gene amplified by RT-PCR and Nested PCR and genotyped by an in-house assay to determine the HIV subtypes. SAMBA-Q showed sensitivity, specificity and concordance of 100% (95% CI: 98.2-100), 99.3% (95% CI: 95.9-99.9) and Cohen Kappa of 0.99 (95% CI: 0.98-1.00) respectively. Similarly, SAMBA-SQ showed sensitivity, specificity and concordance of 92.0% (95% CI: 84.8, 96.5), 98.0% (95% CI: 93.0, 99.8) and Cohen Kappa of 0.90 (95% CI: 0.84- 0.96) respectively. The frequency of discrepancies between SAMBA and CAP/CTM was 2% (11/535).Among the 10successfully genotyped specimens 60% (n=6)were circulating recombinant forms (CRFs) AD(n=5)and AC(n=1) while 40% were pure subtype A1 (n=3)and A(n=1).SAMBA-Q and SAMBA-SQ had comparable accuracy and reliability to CAP/CTM in detecting and quantifying HIV hence should be considered for adoption as a POC to increase access to EID and VL testing in Western Kenya.

Immunohistochemical Evaluation of The Differention-Related Gene-1 Expression inaAnd Survival Rates of er Breast Cancer Women Patients Attending Moi Teaching and Referral Hospital in Kenya

2016-01-01T00:00:00Z

Immunohistochemical Evaluation of The Differention-Related Gene-1 Expression inaAnd Survival Rates of er Breast Cancer Women Patients Attending Moi Teaching and Referral Hospital in Kenya BOR, Hillary Breast cancer is a disease that affects both men and women and currently the leading type of cancer in women globally, commanding a huge social and health impact. Approximately 52.5% of breast cancer cases express estrogen receptors (ER). ER is a receptor proteins type of breast cancer and it fuels growth of breast cancer. ER breast cancer which has been shown to be the most aggressive and misdiagnosed thus, leading to overtreatment. However, it has not been study in Africans Kenyan women. Age is one of the factors that contribute to breast cancer conditions. Women of 40 years and above have been shown to be the most vulnerable group to breast cancer among the Caucasian women. However, it has not been shown in sub-Saharan African women. Metastasis is the spread of primary tumor to the secondary site and it is the major cause of mortality among breast cancer patients. Differential-Related Gene-1 (DRG1) is a suppressor gene that prevents the spread of tumor to the secondary site without affecting primary tumor. Poor prognosis, prediction of recurrence and management of breast cancer in clinics is a major challenge. However, studying the expression of DRG1as a biomarker in tissue sections in predicting metastasis and recurrence is necessary. This study evaluate the viability of DRG1gene as a prognosis biomarker in breast cancer using cancer tumor blocks and determine, the distribution of age, ER and survival rate of breast cancer patients at Moi Teaching and Referral Hospital (MTRH). Using Cochran (1963) formula, a sample size of 37 tumor blocks was used in this study. The tumor blocks were subjected to histological grading to ascertain the presence of a tumor. Immunohistochemistry technique was used to determine the expression of DRG1 and ER. Rabbit polyclonal anti-DRG1 and rabbit monoclonal anti-ER was used in this study. Data were recorded in a form and images captured on a camera. The most affect age group was between 35 and 50 years and vulnerable to breast cancer due to effects of estrogen hormone. Of the total percent breast cancer, 50% were in grade 2 a second stage of breast cancer. 56.8% were ER positive and all the tumor sections tested for DRG1 were all positive. Even though, all expressed DRG1 and clinically proofed to have metastasis, it was not significant statistically as sample size tested did reach calculated sample size. In addition there was no association between age and DRG1 (p value 0.493). Survival rate of breast cancer patients is 2.18 years thus, it’s poor. This study guides clinicians in prognosis, treatment and management of breast cancer patients.

Performance of kato-katz, mini-parasep and mini-flotac in detection of intestinal helminthes in Mbita, Homabay county, Kenya

2015-01-01T00:00:00Z

Performance of kato-katz, mini-parasep and mini-flotac in detection of intestinal helminthes in Mbita, Homabay county, Kenya IMALI, Annette Schistosomiasis and soil-transmitted helminthiasis remain a serious public health problem that cause significant morbidity and mortality in developing countries. Fishing, car washing and use of fresh waters infested with cercariae for domestic purposes, in addition to soil contaminated by fecal matter, predispose humans to these infections. Kato-Katz has for decades been used as a reliable diagnostic method for most intestinal parasitic infections, but has major drawbacks that include low sensitivity, exposure to infectious agents in stool, and requirement to process and examine stool samples soon after collection. Thus, the combination of Kato-Katz with other diagnostic procedures that allow collection and preservation of stool samples to be processed at a later time will help in logistical organization of surveys, evaluation of effectiveness of interventions and accurate estimation of disease prevalence. This cross-sectional study sought to evaluate the performance of Kato-Katz, Mini-Parasep and Mini-FLOTAC for laboratory detection of Schistosoma mansoni and soil transmitted helminth ova. One stool sample was randomly collected from 282 mother-preschool child pairs and individuals ≥6 years from 4 villages along the shores of Lake Victoria, Mbita. Aliquots for Mini-Parasep and Mini-FLOTAC techniques were preserved in 10% and 5% formalin, respectively, before processing and microscopy, while for Kato-Katz, fresh stool was used. The recovery of intestinal helminth ova by Kato-Katz, Mini-Parasep and Mini-FLOTAC was comparable. Mini-Parasep and Mini-FLOTAC FS7 detected an additional Enterobius vermicularis and Taenia respectively. Using Kato-Katz as reference standard, Mini-Parasep showed a higher sensitivity for detecting S. mansoni (85.0%) and hookworm (33.3%) than Mini-FLOTAC FS7 (27.7% S. mansoni) and Mini-FLOTAC FS2 (8.5% S. mansoni). Kappa statistic for agreement showed a moderate agreement between Kato-Katz and Mini-Parasep (k=0.49), and a fair agreement between Kato-Katz and FS7 (k=0.28) in detecting S. mansoni ova. Using Fisher’s exact test, Mini-Parasep detected more light intensity S. mansoni infections (70.2%), while Kato-Katz detected more heavy intensity S. mansoni infections (16.5%). Spearman correlation showed a significant positive association among the techniques in estimating S. mansoni egg counts such that Kato-Katz vs FS2 was (ϒs, 0.28, p=0.0018), Kato-Katz vs FS7 was (ϒs, 0.40, p=<0.0001), Kato-Katz vs Mini-Parasep was (ϒs, 0.68, p=<0.0001) and FS2 vs FS7 was (ϒs, 0.23, p=0.0085). Mini-Parasep is a promising technique with high sensitivity for S. mansoni and hookworm eggs and is recommended to be included into schistosomiasis and soil transmitted helminth control programs as an alternative to Kato-Katz. This study also recommends the combined use of Mini-Parasep and Kato-Katz in disease surveillance and epidemiological studies to increase diagnostic sensitivity for detecting intestinal schistosomiasis Masters Thesis