KNH-UoN Ethics and Research Committee

No Abstract!

The use of unclaimed bodies for anatomical dissection has been the main method of instruction at our institution. There is however a shortage of cadavers for dissection given the increase in the number of medical schools as well as in the number of students enrolling in these schools. This shortage could be mitigated by having voluntary human body donation programs. This study aimed at assessing the attitudes of medical students and surgical residents towards body donation for anatomy learning. We conducted an online survey involving 72 first-year medical students and 41 surgical residents at University of Nairobi who had completed one year of anatomy dissection. For the medical students, this was their first dissection experience while it was the second exposure for the surgery trainees. Most of the surgical trainees (70.7%) and medical students (68.1%) were opposed to self-body donation. This was mainly due to cultural (37%) and religious (20%) barriers. Surprisingly, of those not willing to donate themselves, 67.9% (82.8% surgical trainees, 59.2% medical students) would recommend the practice to other people. Exposure to repeated dissection does not change the perceptions towards body donation. It is noteworthy that culture and religion rank high as clear barriers amongst this "highly informed" group of potential donors.

Introduction: The use of innovative ways of teaching anatomy as well as shortage of cadavers for dissection
have raised questions as to whether dissection should continue to be used in teaching anatomy. This study
aimed to assess the views of medical and dental students on the importance of dissection in learning gross
anatomy, and whether they would prefer other ways of learning anatomy instead of cadaveric dissection.
Materials and Methods: First‑ and second‑year students enrolled at the University of Nairobi (Kenya) were
asked to fill an online questionnaire. Data gathered were analyzed using Statistical Package for Social Sciences.
Results: Ninety‑eight (83 medical and 15 dental) students participated in the study. All students agreed dissection was useful in learning anatomy. Up to 95.2% of medical and 86.7% of dental students favored dissection. Most students strongly agreed or agreed that dissection helped them to develop three‑dimensional (3D) awareness of the human body (94.9%), work as a team (89.8%), learn medical terminology (85.7%), and learn how to use basic surgical instruments (80.6%). Dissection was preferred to use of 3D models, prosected specimens, computer‑aided learning techniques, or modern imaging techniques by 63.3%, 60.3%, 37.7%, and 34.4% of the students, respectively.
Conclusion: Dissection is an important resource for learning anatomy. Other teaching techniques should be
used to supplement dissection rather than replace it.

Key words: Anatomy, cadaveric dissection, medical students

As the Lord Jesus faced imminent death upon the Cross, He dedicated all His beloved disciples to a love relationship with His Mother saying, “Behold your mother!” St. John was present at the foot of the Cross, representing all mankind. And from that hour, he took her into his home. This commissioning of the Blessed Virgin Mary as Mother of all mankind illustrates the great love with which the LORD Jesus offered His life for all peoples - by giving us the gift of His mother. All are to comprehend that Mary has an active role to play in our faith and in our spiritual life. We acknowledge that this is how the LORD Jesus wished to bring His Sacrifice to completion by entrusting His mother to His beloved disciple, and in the beloved disciple to all mankind. It is a concrete maternal love relationship between Mary and all who trustingly commend themselves to her care. Under the watchful eye of Mary is a spiritual journey where we learn from the Blessed Mother of God what living a worthy discipleship in the LORD is, and we meditatively pray with the Blessed Mary as the first Christian Community did before Pentecost.

SUMMARY: Monocular deprivation results in anatomical changes in the visual cortex in favor of the non-deprived eye. Although the retina forms part of the visual pathway, there is scarcity of data on the effect of monocular deprivation on its structure. The objective of this study was to describe the effects of monocular deprivation on the retinal ganglion cell dendritic features. The study design was quasi-experimental. 30 rabbits (18 experimental, 12 controls) were examined. Monocular deprivation was achieved through unilateral lid suture in the experimental animals. The rabbits were observed for three weeks. Each week, 6 experimental and 3 control animals were euthanized, their retina harvested and processed for light microscopy. Photomicrographs of the retina were taken using a digital camera then entered into FIJI software for analysis. The number of primary branches, terminal branches and dendritic field area among the non-deprived eyes increased by 66.7%(p=0.385), 400%(p=0.002), and 88.4%(p=0.523) respectively. Non-deprived eyes had 114.3% more terminal dendrites (p=0.002) compared to controls. Among deprived eyes, all variables measured had a gradual rise in the first two weeks followed by decline with further deprivation. There were no statistically significant differences noted between the deprived and control eyes. Monocular deprivation results in increase in synaptic contacts in the non-deprived eye, with reciprocal changes occurring in the deprived eye.
KEY WORDS: Monocular deprivation; Retina; Retinal Ganglion Cells; Dendritic features; Eye.

Introduction: The histoarchitecture of the tunica media of the Atriopulmonary Junction (APJ) has not been extensively studied and yet the tunica media is the backbone, which provides the structural strength for optimum function. This study therefore strives to unravel the structural components of the tunica media of the APJ.
Methods: The study design was a descriptive cross-sectional study. Histological studies were done on tissues from the APJ of 20 hearts using light microscopy. The proportion of elastic fibers in the tunica media of the APJ was determined using the point intercept method by dropping a grid in ImageJ software.
Results: The smooth muscle cells were concentric and more prominent in males extending the entire extent of the tunica media compared to females where they were confined to the intimal side of tunica media. The collagen bundles were mainly longitudinal. The elastic fibers showed a diverse pattern of organization and side and sex differences in orientation and quantity.
Conclusion: Gender and regional variations in the histology of the tunica media of the pulmonary veins suggest a mechanism for controlling hemodynamic forces at the APJ.
Keywords: Tunica media; Atriopulmonary junction

When I made the decision to make prayer a part of my daily activities, I found myself drawn to it by an inner yearning that made me look forward to those moments. Initially I prayed for my own needs, then for those close to me, then for those who asked me to pray for them. There emerged a noticeable pattern of how I prayed. It was by a movement of my heart in prayer, over which I had absolutely no control. I only needed to start praying and I would find myself drawn to particular groups or situations to pray for - ‘the unborn’, ‘the departed souls’, ‘peace in families’, ‘mothers’, ‘priests’, ‘the unemployed’. One time, while I was praying the rosary, I felt drawn to pray for missionaries. When I finished, I went to my workplace and immediately did an internet search on “missionary rosary”. I came across the “world mission rosary” that was inaugurated by Venerable Archbishop Fulton J. Sheen with these words, “We must pray, and not for ourselves, but for the world.”
Praying with this rosary became my transformation into intercessory prayer for all the peoples of the world. The joy that I found in intercession drew me to do some research work on intercession as a gift and as a ministry. That which I thought was something that is for a specific group of people turned out to be an open invite to all who are baptized Christians. I found this to be one area we can and should take up seriously our baptismal commitment as priests, prophets and kings. Thus, I decided to share my findings with all those who are probably desirous to serve in this ministry by coming up with “Standing in the Gap: an invite to minister as intercessor”. Will you?

No Abstract!

No Abstract!

No Abstract!

To describe the morphometry of the fibular incisura in a sample Kenyan population, a total of 156 tibiae were obtained for the present study from the Department of Human Anatomy, University of Nairobi and the osteology collection of the National Museums of Kenya, Nairobi. The height, width and depth of the fibular incisura as well as the length of the anterior and posterior incisural tubercles were measured using a digital pair of vernier calipers (SealeyProfessional ToolsTM). Average values for the height, depth and width of the fibular incisura were 32.35± 4.14mm, 3.44±0.87mm and 21.50±2.37mm respectively while average lengths of the anterior and posterior tubercles of the fibular incisura were 11.40±1.89mm and 16.11±2.08mm respectively. Majority of tibiae (75%) had a shallow concave fibular incisura (< 4.0mm). There were statistically
significant differences between males and females in all these dimensions. Shallow fibular incisurae in the majority of the tibiae studied, as well as the predominant shallower, shorter incisurae in female subjects suggests an inherent osteological weakness in the tibiofibular syndesmosis. Data obtained in the current study provides baseline values to guide interpretation of diagnostic images.

Key words: Fibular incisura, tibio-fibular syndesmosis.

Craniometric parameters including cranial and orbital indices have been employed to determine the sex of a person in forensic medicine. These parameters are usually population specific. However, they have not been documented for a black Kenyan population. This study aimed at calculating the sex differences in the cranial and orbital indices. The cranial vault height, glabellomaximal length and orbital height and length were measured from 150 crania (80 male and 70 female) using a sliding vernier caliper. Cranial and orbital indices were calculated and the results were analyzed. The cranial index was 71.04 for the male and 72.37 for the female (P=0.095). The orbital index was 82.57 and 83.48 for the male and female, respectively (P=0.472). From these results, although the cranial and orbital indices are within range of previously reported values for an African population, they cannot be used independently in sexing of black Kenyan crania.

Introduction: The present study was planned to determine the utility of distal tibial dimensions in estimation of the length of the tibia in a Kenyan population.
Materials and methods: A total of 156 tibiae were obtained for the present study from the Department of Human Anatomy, University of Nairobi and the osteology collection of the National Museums of Kenya, Nairobi. Measurements were taken directly from the bone using a digital pair of vernier calipers (Sealey Professional ToolsTM). Morphometric data were analyzed and measurements were expressed in means ± standard deviation. For those dimensions that showed a linear association with the length of the tibia, Pearson’s correlation test was carried out. Linear regression to derive equations for estimation of the length of the tibia was carried out.
Results: The height of the fibular incisura, breadth of the medial malleolus and the length and width of the tibial plafond displayed moderate linear association with the length of the tibia. The linear regression models generated for length estimation yielded low coefficients of determination.
Conclusion: Though, it is possible to estimate the length of the tibia from its distal dimensions, caution should be observed when using these dimensions because the estimates from the equations incorporating them have low accuracy.

Introduction: The present study was planned to determine sexual dimorphism in the morphometry of the tibial plafond and medial malleolus in a sample Kenyan population.
Materials and methods: A hundred and fifty six tibiae from the Department of Human Anatomy, University of Nairobi and the osteology collection of the National Museums of Kenya, Nairobi were used. Measurements were taken directly from the bone using a digital pair of vernier calipers (Sealey Professional ToolsTM). Means and frequencies were determined and compared using Student’s t-test. Data are presented using tables.
Results: The mean width of the tibial plafond was 26.55 mm ± 2.18 mm (range 21.7-35.4 mm). The average the length of the tibial plafond was 28.61 mm ± 2.29 mm (range 21.7-36.2 mm). The average height of the medial malleolus was 14.19±1.89mm, whilst the average breadth of the medial malleolus was 21.88±2.22 mm. There were statistically significant differences between males and females in these dimensions with males having larger measurements of the same.
Conclusion: These are baseline data on the osteometric characteristics of the tibial component of the talocrural joint in adult Kenyans. The statistically significant differences in these dimensions in males and females are important in interpreting diagnostic images and guiding the continued design of ankle joint prostheses.

The horizontal angle of inclination, is important in maintaining the function of the temporomandibular joint. It should be maintained in the manufacture of condylar prostheses since deviation may lead to disk displacement and degeneration of the articular fossa. While inter-population variations exist in mandibular morphometry, published information on the horizontal angle of inclination in the African population is not available. This study therefore aimed to determine the normal range of the horizontal angle of inclination amongst Kenyans. Sixty three mandibles of African origin were used. The horizontal angle of inclination was measured as the angle between the medio-lateral axis and the coronal plane. Data collected were analyzed using SPSS v.17 for means and variance, and represented using tables, charts and photographs. The horizontal angle of inclination was larger on the right (22.55°) than on the left (20.01°) (p = 0.002). The mean angle was larger on the right (24.76° vs. 21.75° in males) but smaller on the left in females (17.80° vs. 20.37° in males), but the difference was not statistically significant. The difference between right and left angles was larger in females (6.96°, p < 0.05) than in males (1.38°, p > 0.05). It differed significantly between the left and the right. This difference was more pronounced in females than in males for unknown reasons. The horizontal angle of inclination in Kenyans was different from those reported in general literature, and manufacturers of condylar prostheses need to factor these variations during fabrication to avoid post-operative morbidity.
Key words: Mandibular condyle, angle of inclination

Orbital morphometry is an important consideration during surgical procedures such as reconstruction of the face and cranium. These are done to restore lost functional capacity or to improve cosmetic appearance. Periorbital and intraorbital neurovascular structures risk relative damage during these maneuvers. A thorough understanding of orbital anatomy is therefore essential in avoiding surgical complications. The aim of this study was to describe the average orbital distances and depths from known identifiable anatomical landmarks. One hundred and thirteen adult crania obtained from National Museum of Kenya, Nairobi were examined. Measurements of superior and inferior orbital depths and the biorbital and marginofissural distances were taken using a sliding vernier caliper and their mean measurements documented. The superior orbital depth was 53.38mm in males and 52.03mm in females. The inferior orbital depth was 55.17mm in males and 53.76mm in females. The marginofissural distance was 23.79mm and 22.30mm in males and females respectively. The biorbital breadth was 99.49mm in males and 96.43mm in females while the interorbital distance was 18.91mm in males and 18.26mm in females. This study proposes that orbital measures be given special consideration during orbital reconstruction. A depth of 53mm is recommended as a safe superior orbital depth during operations involving the deep orbit. Similarly, on the orbital floor 55mm into the orbital cavity should be considered safe from the optic nerve.
Key words: orbital measurements, facial cosmetic surgery, facial plastic surgery, orbital reconstruction, orbital anesthesia

No Abstract!

Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. They can also be misinterpreted as osteolytic lesions in cross-sectional imaging of the sternum. On the other hand, variant xiphoid morphology such as bifid, duplicated, or trifurcated may be mistaken for fractures during imaging. The distribution of these anomalies differs between populations, but data from Africans is scarcely reported. This study therefore aimed to investigate the distribution and frequency of sternal foramina and variant xiphoid morphology in a Kenyan population. Eighty formalin-fixed adult sterna (42 males [M], 38 females [F]) of age range 18-45 years were studied during dissection at the Department of Human Anatomy, University of Nairobi. Soft tissues were removed from the macerated sterna by blunt dissection and foramina recorded in the manubrium, body, and xiphoid process. The xiphisternal ending was classified as single, bifurcated (2 xiphoid processes with a common stem), or duplicated (2 xiphoid processes with separate stems). Results were analysed using SPSS version 17.0. Foramina were present in 11 specimens (13.8%): 7 M, 4 F. The highest frequency was in the sternal body (n = 9), where they predominantly occurred at the 5th intercostal segment. Xiphoid foramina were present in 2 specimens (both males) (2.5%), while manubrial foramen was not encountered. The xiphisternum ended as a single process in 64 cases (34 M, 30 F) (80%). It bifurcated in 10 cases (5 M, 5 F) (12.5%), and duplicated in 6 cases (4 M, 2 F) (7.5%). There were no cases of trifurcation. Sternal foramina in Kenyans vary in distribution and show higher frequency than in other populations. These variations may complicate sternal puncture, and due caution is recommended. The variant xiphisternal morphology may raise alarm for xiphoid fractures and may therefore be considered a differential.

SUMMARY: Position and source of blood supply to the human carotid body displays population variations. These data areimportant during surgical procedures and diagnostic imaging in the neck but are only scarcely reported and altogether missing for theKenyan population. The aim of this study was to describe the position and blood supply of the carotid body in a Kenyan population. Adescriptive cross-sectional study at the Department of Human Anatomy, University of Nairobi, was designed. 136 common carotidarteries and their bifurcations were exposed by gross dissection. The carotid body was identified as a small oval structure embedded inthe blood vessel adventitia. Position and source of blood supply were photographed. Data are presented by tables and macrographs. 138carotid bodies were identified. Commonest position was carotid bifurcation (75.4%) followed by external carotid artery (10.2%), internalcarotid artery (7.2%) and ascending pharyngeal artery (7.2%). Sources of arterial blood supply included the carotid bifurcation (51.4%),ascending pharyngeal (21.0%), external carotid (17.4%) and internal carotid (10.2%) arteries. Position and blood supply of the carotidbody in the Kenyan population displays a different profile of variations from those described in other populations. Neck surgeons shouldbe aware of these to avoid inadvertent injury.KEY WORDS: Carotid body; Position; Variations; Kenyan.

No Abstract!

No Abstract!

SUMMARY: Mitral valve cusps consist mainly of connective tissue and myocardium. Connective tissue fibres within the cusps have been demonstrated to exhibit sex variations in organisation. Mitral prolapse, a disease attributed to defects within the cusps occurs more commonly in females. Sex variations in valvular myocardium however remain to be studied. Possible variations in its organisation may enhance understanding of sex differences in prevalence of mitral prolapse. The aim of this study was to determine anatomical variations of mitral valvular myocardium by sex; by mean a comparative cross-sectional study. A total of 48 (27 male and 21 female) adult heart specimens obtained during autopsy at Nairobi City and Chiromo mortuaries after ethical approval were used. Valvular cusps were then harvested. Four – millimetre sections were made at the area of maximum width for both anterior and posterior cusps. These were processed for paraffin-embedding and sectioning and stained with Masson’s trichrome and Weigert’s resorcin fuchsin with Van Gieson counterstain to demonstrate cardiac muscle, collagen and elastic fibres. Both anterior and posterior cusps demonstrated three histological laminae, that is, atrialis, fibrosa and ventricularis. Only lamina atrialis contained cardiac muscle. This lamina in males was characterised by a transversely oriented subendothelial myocardial strip while that in females contained compact longitudinal elastic fibres but no muscle. The presence of cardiac muscle in the lamina atrialis may be relatively rotective against mitral valve prolapse in males compared to females.

KEY WORDS: Mitral valve; Cusp; Structure; Variation; Sex.

Objectives: To determine the frequency of adenotonsillectomy in a sample of Kenyan hospitals and to review indications, timing and complications in 97 cases of adenotonsillectomy done by the authors.
Design: Retrospective, descriptive study.
Setting: Kenyatta National, Nairobi, Aga Khan, Gertrude and Mater Hospitals.
Results: Adenotonsillectomy is the most frequent otolaryngologic surgical operation. Indications for surgery were upper airway obstruction in 61.3%, recurrent tonsillitis in 28.7% and both in 7.5%. Surgery was indicated during the acute stage in 6.8% of cases. There was one case of post-operative acute airway obstruction. Post operative bleeding from the tonsillar bed was encountered in 2.1 % of cases.
Conclusion: Adenotonsillectomy is the most common otolaryngologic surgical operation in our set-up. The low frequency of complications and a short hospital stay puts up a case for routine adenotonsillectomy as a day surgery procedure.