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Biomedical subjects

H O Oburra

Publications and source records attributed to H O Oburra.

8 recordsLinked to original sources

[Otorhinolaryngology, head and neck surgery in Kenya--consequences of demographic parameters].

BACKGROUND: In the time of evidence based medicine the analysis of the influence of demographic parameters and different environmental factors on the treatment concepts in a country is often neglected. This is also true for Otorhinolaryngology. METHOD: An evaluation of the situation concerning distribution of physicians, diagnostic procedures and epidemiology in Kenya has been performed. These factors are discussed in consideration of their effect on the incidence of different diseases and their treatment under the specific socio-economic conditions for the otolaryngological situation in Kenya. RESULTS: In Kenya 28 otolaryngologists are registered that concentrate on few urban regions. Chronic otitis media, malignant tumors in the head and neck region and AIDS associated diseases have meanwhile increased dramatically. Numerous instruments and equipment for diagnosis are missing. Bigger equipment for CT scans are nearly exclusively used by private hospitals. PERSPECTIVE: Beside a better provision with different equipment for diagnosis it is especially the organization of certain training programmes where local physicians are further educated that may lead to an optimised medical care in Kenya.

Cross-Cultural Comparison↗

Distant metastases from nasopharyngeal carcinoma at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To determine the frequency and site of distant infraclavicular metastases of nasopharyngeal carcinoma (NPC), the stage of the primary tumour at presentation of metastasis and the histological trends. To determine if there is a correlation between the follow-up rate and different metastatic sites. DESIGN: A retrospective study. SETTING: Ear nose and throat surgical and radiotherapy clinics at Kenyatta National Hospital, Nairobi. SUBJECTS: Case notes, radiotherapeutic and laboratory records of patients presenting with NPC between January 1981 and December 1990. RESULTS: The frequency of distant NPC metastases was 14.6% and 92.3% manifested within 24 months of admission. It was most frequent in the males, a younger age group and early T1 disease. Bilaterality of the neck nodes had no relevance on metastatic rate. The bone (66.7%) was the most common distant metastatic destination followed by the liver (23.2%). Liver metastasis was associated with a shorter follow-up period. CONCLUSION: Apart from the late presentation of locoregional disease, the findings are similar to studies elsewhere. The preponderance of early primary disease in patients with distant metastasis need further appraisal as it preliminarily suggests existence of specific biological markers that favour metastases. This can only be done after recruiting more cases.

Adolescent↗

Frequency of adenotonsillectomy in some Nairobi hospitals.

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.

Adenoidectomy↗

Late presentation of laryngeal and nasopharyngeal cancer in Kenyatta National Hospital.

The clinical stage at presentation of laryngeal and pharyngeal cancer is an important determinant of survival. Fifty six patients admitted at Kenyatta National Hospital with nasopharyngeal and laryngeal carcinoma were reviewed to determine the period of delay from onset of illness to the first otolaryngologic appointment at the hospital, their clinical features and the tumour stage at presentation. All cases of nasopharyngeal carcinoma had cervical lymphadenopathy, 70.6% being N3 status while 57.8% of laryngeal carcinoma cases underwent emergency preoperative tracheostomy due to bulky obstructive tumour. On the whole, 96.4% of the patients presented with advanced (stage 3 or 4) head and neck carcinomas. The average period of delay between the first medical attention at a primary health care facility and the first appointment at the national hospital was 8.7 months. The study suggests that this long delay was due to inherent inefficiency in the referral system and was a major contributing factor to the advanced stage at presentation.

Adolescent↗

Causes of ear trauma in Kenyan patients.

Ear trauma is one of the most important epidemiological factors in causation of deafness. The causation of otologic trauma in eighty three patients is analysed. The triad of pain, hearing loss and tinnitus comprised the most frequent presenting complaints. Physical assault was the most common causation in 49.4% of the cases, road traffic accidents in 19.3% and self-inflicted injury in 15.6%. Law enforcement agencies constituted the most prominent factor in assault cases. Iatrogenic trauma was confined to 13.3% who were all below ten years of age. Road traffic accidents and violence from law enforcers were significant contributors to severe otologic damage as defined by dead ears and cerebrospinal otorrhoea.

Accidents, Traffic↗

Complications following bilateral turbinectomy.

Thirty four patients undergoing bilateral inferior turbinectomy for obstruction of the upper airway are prospectively reviewed. The indication for the operation was persistent nasal obstruction interfering with sleep and speech. Their ages ranged from seven years to 50 years. The most common post operative complications were synaechiae (15%), atrophic rhinitis (15%), persistent obstruction (12%) and abnormal nasal sensation (9%).

Adolescent↗