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Biomedical subjects

A M Adam

Publications and source records attributed to A M Adam.

At least 19 recordsLinked to original sources
PubMed2005

Creutzfeldt-Jakob disease in Kenya.

OBJECTIVE: To study the pattern of occurrence of Creutzfeldt-Jakob disease (CJD) in Kenya. Study design Prospective, cross-sectional, descriptive study of clinical, encephalographic and natural history of CJD, backed by histology in as many patients as possible. METHODS: Consecutive patients presenting with the criteria laid down by WHO expert committee for diagnosis of CJD were recruited between January 1990 and May 2004. We analysed the clinical features and electroencephalography of all participants and took brain biopsies from four patients. RESULTS: There were four definite, seven probable and two possible cases. The electroencephalographic and histological features were typical of sporadic CJD. CONCLUSION: Sporadic CJD occurs in Kenya and the clinical, encephalographic and histological features were no different to those described elsewhere. Although we did not see variant, hereditary and iatrogenic forms of CJD, neurologists should not exclude these in making diagnoses.

Aged↗
PubMed2005

Benign positional vertigo and hyperuricaemia.

OBJECTIVE: To find out if there is any association between serum uric acid level and positional vertigo. DESIGN: A prospective, case controlled study. SETTING: A private neurological clinic. SUBJECTS: All patients presenting with vertigo. RESULTS: Ninety patients were seen in this period with 78 males and 19 females. Mean age was 47 +/- 3 years (at 95% confidence level) with a standard deviation of 12.4. Their mean uric acid level was 442 +/- 16 (at 95% confidence level) with a standard deviation of 79.6 umol/l as compared to 291 +/- 17 (at 95% confidence level) with a standard deviation of 79.7 umol/l in the control group. The P-value was less than 0.001. CONCLUSION: That there is a significant association between high uric acid and benign positional vertigo.

Case-Control Studies↗
PubMed1998

Some effects of the rising case load of adult HIV-related disease on a hospital in Nairobi.

Increasing numbers of HIV-infected adults in Africa need hospital care. It remains unclear what impact this has on health care services or on how hospitals respond. The aim of this study was to describe the effects of a rising case load of adult HIV-related disease by comparing results from a prospective cross-sectional study of acute adult medical admissions to a government hospital in Nairobi conducted in 1992 with results from a previous study done in 1988 and 1989 in the same hospital, using the same study design and protocol. Data on age, gender, number admitted, length of stay, HIV status, clinical AIDS, final diagnosis, case mix, and outcome were compared. In 1992, 374 consecutive patients were admitted in 15 24-hour periods (24.9 patients/period) compared with the 1988 to 1989 study, which enrolled 506 patients in 22 24-hour periods (23.0 patients/period). Patients' age, gender, and length of hospital stay were similar in both studies. In 1992, 39% of patients were HIV-positive compared with 19% in 1988 to 1989 (p < 10(-6)); whereas seropositive admissions rose 123% between the two periods (p < .0001), HIV-negative admissions declined 18% (p < .05). Clinical surveillance for AIDS consistently identified <40% of HIV-positive patients. Irrespective of HIV status, tuberculosis and pneumococcal pneumonia were the leading diagnoses in both surveys. No change was found in the diagnoses recorded for HIV-positive patients, but in HIV-negative patients, reductions were significant in the case mix (p < .00001) and range of diagnoses (p < .001) seen in 1992. Outcome remained unchanged for HIV-positive patients with approximately 35% mortality in both surveys. Outcome significantly worsened, in relative and absolute terms, for HIV-negative patients: in 1992, mortality was 23%, compared with 13.9% in 1988 to 1989 (p < .005), with 3.5 deaths per 24-hour period in 1992 compared with 2.6 deaths per 24-hour period in 1988 to 1989 (p < .05, one-tailed). These data suggest that increasing selection for admission is taking place as demand for care increases because of HIV/AIDS. This process appears to favor HIV-positive patients at the expense of HIV-negative patients who seem to be crowded out and, once admitted, experience higher mortality rates. The true social costs of the HIV epidemic are underestimated by not including the effects on HIV-negative people.

Adult↗
PubMed1993

Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report.

A 27 year old female with AIDS and disseminated histoplasmosis is presented. The clinical features include fever, weight loss, productive cough, splenomegaly and moderate pallor. The initial working diagnosis was pulmonary tuberculosis. The diagnosis of disseminated histoplasmosis was made terminally from bone marrow aspirate examination. Disseminated histoplasmosis with its varied clinical picture is likely to be missed in a patient with AIDS, and therefore a high index of suspicion is necessary for diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1992

Unusual form of motor neuron disease in Kenya.

Over the period November 1978 to October 1988, 46 cases of motor neuron disease were seen at Kenyatta National Hospital, Nairobi. One case was seen in private practice. A bimodal age distribution of the disease was identified with a peak in the fourth decade of life and another peak in the sixth decade of life. The disease seen in the fourth decade of life was different as seen in other parts of the world in that the majority of patients tended to present with very rapidly progressive disease despite the primary presentation with limb symptoms and signs. Serum cholinesterase activity in five of these patients and five of the classical motor neuron disease revealed no abnormalities. This unusually rapidly progressive disease in young adults has not been described anywhere. The disease seen in older age groups and especially in patients over fifty years of age was not different from the one seen in other parts of the world.

Adolescent↗
PubMed1989

Multiple sclerosis: epidemic in Kenya.

Over a period of five years, November, 1983 to October, 1988 six cases of definite multiple sclerosis were identified at Kenyatta National Hospital. Four were females and two were males. Age of onset of disease ranged from 12 years to 30 years. Their mode of presentation, clinical features and prognosis is the same as that of multiple sclerosis seen at higher latitudes. The consequences of misdiagnosis to the patient is discussed. A theory is put forward to explain the increased numbers of MS seen recently as compared to the past decades.

Adolescent↗
PubMed1987

Skull radiograph measurements of normals and patients with basilar impression; use of Landzert's angle.

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

Black People↗
PubMed1985

High-performance liquid chromatographic assay for simultaneous estimation of aminoglutethimide and acetylaminoglutethimide in biological fluids.

A simple rapid high-performance liquid chromatographic assay for simultaneous estimation of aminoglutethimide and its acetylated metabolite acetylamidoglutethimide in plasma, saliva, and urine is described. This assay is suitable for pharmacokinetic studies in normal subjects and patients receiving other medication in addition to aminoglutethimide.

Aminoglutethimide↗
PubMed1984

Gas--liquid chromatographic assay of aminoglutethimide and a high-performance liquid chromatographic assay for its acetyl metabolite in biological fluids.

A rapid, sensitive and selective gas--liquid chromatographic assay for aminoglutethimide is described. The same extraction procedure may be employed prior to a high-performance liquid chromatographic assay for acetamidoglutethimide which is also detailed. Both assays are suitable for the study of the pharmacokinetics of aminoglutethimide and acetamidoglutethimide in biological fluids in man.

Aminoglutethimide↗
PubMed1984

The effect of acetylator phenotype on the disposition of aminoglutethimide.

Aminoglutethimide (AG) 500 mg was administered orally to four normal volunteers and eight patients undergoing treatment for metastatic breast cancer. In each subject the acetylator phenotype was established from the monoacetyldapsone (MADDS)/dapsone (DDS) ratio. Acetylaminoglutethimide (acetylAG) rapidly appeared in the plasma and its disposition paralleled that of AG. A close relationship (P less than 0.01) was observed between the acetyl AG/AG and MADDS/DDS ratio suggesting that AG may undergo polymorphic acetylation like DDS. AG half-life was 19.5 +/- 7.7 h in seven fast acetylators of DDS and 12.6 +/- 2.3 h in five slow acetylators and its apparent metabolic clearance was significantly (P less than 0.01) related to the acetylAG/AG ratio. Over 48 h the fast acetylators excreted 7.7 +/- 4.4% of the administered AG dose in the urine as unchanged AG as compared to 12.4 +/- 2.8% in slow acetylators. A much smaller fraction of the dose was excreted as acetylAG: 3.6 +/- 1.5% by fast and 1.9 +/- 1.0% by slow acetylators respectively. After 7 days treatment with AG at an accepted clinical dose regimen to the eight patients there were significant reductions in the half-lives of AG (P less than 0.01) and acetylAG (P less than 0.01) and a trend (0.1 greater than P greater than 0.05) towards reduction of the acetylAG/AG ratio which became significant (P less than 0.05) if the one patient on a known enzyme inducer was omitted. The mean apparent volume of distribution was not significantly (P greater than 0.1) altered but the mean apparent systemic clearance of AG was increased (P less than 0.05). These changes are attributed to auto-induction of oxidative enzymes involved in AG metabolism.

Acetylation↗