Comprehensive Care Clinic Research Articles

Outcomes of Nonsurgical Periodontal Therapy in Gingivitis and Periodontitis Patients Treated by Senior Dental Students.

This retrospective study aimed to evaluate the outcomes of nonsurgical periodontal therapy performed by senior dental students. Electronic records of patients treated by senior dental students at the comprehensive care clinic in King Abdulaziz University Dental Hospital were reviewed retrospectively. Patients diagnosed with gingivitis or periodontitis who had undergone at least one session of scaling and root planing were included in this study. The following periodontal parameters were assessed: BOP, PI, PD and number of residual pockets. A total of 618 patients were included in this study (60.2% females and 39.8% males). BOP reduced from a median of 40% (IQR: 26.0%-62.0%) at baseline to 13% (IQR: 9.0%-20.3%) at re-evaluation in the gingivitis group (p < 0.0005). Similarly, a significant reduction in BOP, from 45% (IQR: 28.0%-64.3%) at baseline to 14% (IQR: 9.0%-21.5%) after phase I therapy, was observed in the periodontitis group (p > 0.001). In both groups, 31%-32% of patients had BOP < 10 at re-evaluation. PD of ≥ 5 mm was observed in 50.8% of patients with periodontitis at baseline; however, 38% of these patients had no residual pockets at re-evaluation. NSPT performed by senior dental students was effective in improving the periodontal status of the patients. Both gingivitis and periodontitis patients showed significant improvement in BOP and PI. Approximately, 32% of patients showed a reduction in BOP suggestive of a bleeding score associated with periodontal health. Moreover, patients diagnosed with periodontitis exhibited a significant reduction in the number of sites with deep probing (≥ 5).

Level of Cardiovascular Disease Risk and Associated Factors among Clients on Highly Active Antiretroviral Therapy in Vihiga County, Kenya

Context: HIV/AIDS is still a public health concern globally, especially in sub-Saharan Africa and Kenya. HIV-positive clients are initiated on highly active antiretroviral therapy (HAART) to reduce the multiplication of HIV and improve their immunity. These clients are at an increased cardiovascular disease risk due to a complex interplay of factors, including traditional cardiovascular risk factors such as smoking cigarettes, obesity due to inactivity, and diabetes. Aim: This study sought to determine the level of cardiovascular disease (CVD) risk factors among people living with HIV (PLHIV) on highly active antiretroviral therapy (HAART) in Vihiga County, Kenya. Methods: The study employed a cross-sectional survey design to report baseline survey data for an interventional study on the level of CVD risk factors. The study involved a systematic sample of 211 patients on HAART in six health facilities purposively selected from Vihiga County. Data was collected using the WHO STEPWISE questionnaire from six comprehensive care clinics in Vihiga County from March to July 2022. The World Health Organization-International Society of Hypertension (WHO-ISH) tool AFRI E CHART was used to estimate the cardiovascular risk. Results: The majority (96.68%) of PLWHIV on HAART in Vihiga county had low overall cardiovascular risk as predicted WHO/ISH score. Age (OR = 1.199, 95% CI [1.031, 1.394], p = 0.018) and smoking status (OR = 0.115, 95% CI [0.024, 0.558], p = 0.007) exhibited a significant association with the level of cardiovascular risk. Conclusion: The majority of PLHIV have a low estimated CVD risk. There is a need to prioritize weight management in HIV care, integrating healthy lifestyle behaviors and nutritional support while conducting regular cardiovascular risk assessments, focusing on modifiable factors like smoking. Age-specific interventions can also help mitigate the risk across the different age groups.

A Novel Newborn Screening Program for Sickle Cell Disease in Nigeria.

Newborn screening for sickle cell disease (SCD) is sparse in sub-Saharan Africa. The leadership of the Aminu Kano Teaching Hospital (AKTH) in Kano, Nigeria, with the support of local religious authorities, established a groundbreaking SCD newborn screening program that has become the standard of care for pregnant women and their newborns. Our program includes (1) prenatal genetic counseling for all pregnant women in the antenatal clinic, (2) newborn screening, (3) postnatal genetic counseling for parents of newborns diagnosed with SCD and SCT, and (4) referral of newborns with SCD for follow-up in the SCD Comprehensive Care Clinic by 3 months of age. From September 2020 to December 2023, the team screened 7530 infants for SCD at the AKTH, identifying 126 (1.7%) infants with SCD and 1546 (20.5%) with SCT. Of these, 93 (73.8%) newborns with SCD received individualized genetic counseling, and 43 (46%) were referred to the SCD Comprehensive Care Clinic before 3 months. Group genetic counseling was provided to the parents of 778 (50.3%) of newborns identified with SCT. The SCD newborn screening at the AKTH is now standard care, indicating the viability of sustaining an SCD newborn screening program that provides pre- and postnatal genetic counseling and comprehensive SCD care within a low-income setting.

'Addressing HPV vaccine hesitancy: unveiling concerns and building trust' perspectives of adolescent girls and parents in Kisumu County, Kenya.

Human papillomavirus (HPV) causes cervical cancer, and HPV vaccination is highly effective in preventing vaccine-targeted HPV infection. However, low HPV vaccination coverage in Kisumu County, Kenya, at about 10% for the first dose, highlights the critical issue of vaccine hesitancy, particularly in low and middle-income countries. This study explores the concerns, myths and barriers to HPV vaccine uptake among adolescent girls (aged 10-14) enrolled at human immune-deficiency virus comprehensive care clinics and their parents in Kisumu County. Focused group discussions were conducted with 48 participants. Content analysis revealed limited knowledge about the HPV vaccine and widespread misconceptions regarding its safety and efficacy. Financial constraints, injection fears and negative clinic experiences emerged as additional barriers. The findings emphasise the role of effective communication strategies, including engaging parents through written materials and involving them in decision-making, to dispel myths, provide accurate information and encourage HPV vaccination. Collaborative efforts with community stakeholders are crucial to improve vaccine coverage and ultimately reduce the cervical cancer burden.

Centralized care model for hereditary angioedema overcomes geographical barriers.

Hereditary angioedema due to C1 inhibitor deficiency (HAE) is a rare inborn error of immunity that presents with episodic swelling. Management is multifaceted and includes on-demand treatment of swelling episodes, short-term prophylaxis to prevent swelling episodes from procedures, and long-term prophylaxis (LTP) to prevent angioedema on an ongoing basis. All approved on-demand therapies are parenteral, necessitating patient training for home administration, particularly intravenous C1 inhibitor. These complexities can result in care gaps for rural HAE patients. We conducted a cross-sectional study at our Angioedema Center of Reference and Excellence to assess the care provided to urban and rural patients. The proportion of patients receiving LTP, proportion of patients diagnosed as children, and disease control measured using the Angioedema Control Test (AECT) were collected. Logistic and Poisson regression models adjusted for age and sex were used to compare the two groups. The proportion using LTP was similar at 62% and 61% in urban and rural patients, respectively (odds ratio [OR] 1.01 (CI 95% 0.34-2.99)). Among urban patients, 52% were diagnosed as children compared to 60% among rural residents (1.43 (0.37-5.56)). The mean (IQR) AECT score was 14.0 (8.5-15.5) in urban patients and 13.0 (10.0-14.0) in rural patients (Poisson β -0.001 (-0.23-0.23). These data indicate that rural patients received similar high-quality care. We attribute these findings to the centralized care model employed in which HAE patients in the region are seen at a single comprehensive care clinic.

Burden and predictors of anxiety disorder among HIV patients on ART in Nairobi Kenya

Anxiety disorders are prevalent among people living with Human Immunodeficiency Virus (HIV) globally, but data on the prevalence and factors associated with this mental illness are limited among HIV patients on antiretroviral therapy (ART) in Kenya. This study determined the prevalence and correlates of anxiety disorder among HIV patients receiving care and treatment at the Comprehensive Care Clinic (CCC) in Mbagathi Hospital in Nairobi, Kenya. This was a cross-sectional study where 205 eligible and consenting participants were systematically enrolled. The Beck Anxiety Inventory (BAI) Questionnaire was used to assess anxiety levels, with a score of 8 or more indicating moderate to severe anxiety. Structured questionnaires were used to collect information on factors associated with anxiety disorder. Descriptive statistics and logistic regression models were used to analyze data. Of the enrolled 205 patients, 122 (59.5%) were female. The median age and household size were 49 years (Interquartile range IQR 39–54) and 3 people (IQR 2–3) respectively. A large proportion of the participants, 169 (82.4%) were on the first-line ART regimen and the median duration on ART was 13 years (IQR 7–18). Nearly a third of the participants 60 (29.3%) had anxiety disorder. Male participants (adjusted odds ratio—aOR 0.33; 95% confidence interval—CI 0.13–0.78) were less likely to have anxiety disorder. Self-employment (aOR 5.57; 95% CI 2.17–20.06), larger households (aOR 1.48; 95%CI 1.11–2.03) and no history of tuberculosis infection (aOR 2.9; 95% CI; 1.29–6.96) were factors associated with having anxiety disorder. Among PLHIV receiving ART in Nairobi County, Kenya, there is a considerable burden of anxiety disorder which was associated with gender, occupation, household population size and history of tuberculosis infection.

Risk factors for poor treatment outcomes among opioid-dependent clients taking methadone in Mombasa, Kenya.

Background: The Methadone Maintenance Treatment (MMT) program has been proven to be beneficial in reducing illicit opioid use, increasing access to and retention of HIV treatment and other therapies, and reducing HIV transmission, and other drug-related morbidities and mortalities. However, determinants of treatment retention and outcomes for opioid-dependent persons accessing MMT in Kenya are limited. We sought to identify factors contributing to poor treatment outcomes among opioid-dependent persons enrolled in the Mombasa MMT program, between 2017 and 2019. Method: We conducted a retrospective records review for opioid-dependent persons receiving Methadone treatment in the Kisauni MAT clinic enrolled during 2017-2019. We defined poor clinical or health-related treatment outcome as any client Lost-To-Follow-Up (LTFU), turned HIV or Viral hepatitis positive, and/or missed two or more antiretroviral therapy (ART) appointments intake during MMT. Variables abstracted from clinical and pharmacological MMT service delivery tools included socio-demographic characteristics, clinical history, risk factors, and MMT outcomes. Data were analyzed using Epi Info7. We calculated Prevalence Odds Ratios (POR) and 95% Confidence Intervals (CI) to identify factors associated with adverse health outcomes. Results: Of the total 443 eligible records, the mean age was 37years (SD ± 7.2) and males comprised 90.7%. The majority of females clients, 79.1% (34/43), were aged ≤35years, 7.0% (3/43) had no education, 32.6% (14/43) were employed, 39.5% (17/43) were HIV positive and 18.6% (8/43) were HCV-positive. Overall, adverse treatment outcomes were at 27.5% (122/443), namely: LTFU at 22.8% (101/443), new HIV cases at 1.0% (4/391), HCV at 1.2% (5/405), and Hepatitis B Virus (HBV) at 1.2% (5/411), and 1.1% (5/443) died. Of HIV-infected clients linked to Comprehensive Care Clinic (CCC), 3.6% (2/56) defaulted from ART, and 25% (2/8) had detectable Viral Load of those retested. Lack of formal education (POR: 2.7, 95% CI: 1.3-5.7), unemployment (POR: 2.4, 95% CI: 1.4-4.0), and being a Non-Injector (POR: 1.7, 95% CI: 1.0-2.9) were negatively associated with treatment retention. Conclusion: Females were younger, and more educated with higher HIV and HCV prevalence. Being a Non-injector, unemployment, and lack of formal education may increase the likelihood of poor treatment outcomes among MMT clients. Closer monitoring of MMT clients with these characteristics is recommended with the integration of CCC into MMT services.

#1746 Comprehensive kidney care: adopting principles of comprehensive geriatric assessment within an advanced kidney care clinic

Abstract Background and Aims Chronic Kidney Disease (CKD) is increasingly prevalent among older people, a trend that presents significant healthcare challenges. This project introduces the Comprehensive Kidney Care (CKC) clinic model which incorporates elements from Comprehensive Geriatric Assessment within the Advanced Kidney Care clinic. By focusing on a holistic care, this model aims to enhance symptom management, facilitate appropriate referrals, improve documentation, and offer advance care planning (ACP), ultimately to improve care quality for older people with advanced CKD. Method We evaluated 27 patients ≥65 years old with CKD stage 4 and 5, attending the CKC clinic between 23/11/2022 and 22/11/2023. Demographics and clinical characteristics were recorded, including Charlson Comorbidity Index (CCI). Individual symptoms and total score were screened in each clinic using the Integrated Palliative Outcome Score (IPOS)-Renal Symptom Survey. Geriatric impairments were assessed including frailty (Clinical Frailty Scale [CFS]), mobility, polypharmacy (≥5 medications), activities of daily living (ADLs), falls and cognition. Actions were documented, including initiation of ACP discussions and other relevant interventions. Results Patients’ average age was 82 (SD 5.8), they were predominantly male (20 patients, 74%) and had a median eGFR of 18 ml/min/1.73 m2 (IQR 10). They exhibited a high burden of comorbidities (CCI mean 8.4, SD 2) and a high prevalence of geriatric impairments: 74% (20 patients) had a CFS score ≥4, 63% (17) required mobility aids, 26% (7) reported falls, 30% (8) required assistance with ADLs, and all had polypharmacy. IPOS was recorded for 20 patients. Mean total score was 10.25 (IQR 8). Fig. 1 demonstrates the symptoms reported as experienced ‘moderately’ or worse at first IPOS completion. Thirteen patients had more than one IPOS completed, allowing each symptom to be compared at two consecutive clinic attendances 239 times. Symptom improvement was more common than worsening (37 [15.5%] versus 11 [4.6%]). Most times symptoms remained stable (43, 18%) or were absent (132, 55.2%), with a minority appearing 16 times (6.7%). Seventeen relevant actions were identified, including symptom management (14 patients, 51.9%), physical activity advice (7, 25.9%), referrals to other teams (12, 44.4%; 2 referred to more than one), including dietitian (4), psychology (3), frailty team (2), physiotherapy (2), memory assessment clinic, social care, falls clinic and palliative care (1 each). Preferred kidney management was discussed with 9 patients (33%); 9 patients had documented preferences before attending the CKC clinic. Ten (37%) preferred conservative care, 4 (15%) haemodialysis and 13 (48%) remained undecided. Undecided patients had a significantly higher eGFR (median 21 [IQR 4] versus 12 ml/min/1.73 m2 [IQR 6.75], p-value 0.012). ACP was discussed with 8 patients; these patients had higher CFS scores (median 6 versus 4, IQR 1.25, p-value 0.005) and higher ADL dependence (Odds ratio 8.9, p-value 0.026). Conclusion The CKC clinic model shows promise as an effective approach for assessing and managing older people with advanced CKD. Most times symptoms improved or remained unchanged, suggesting actions were effective at managing symptom burden. ACP discussions were more commonly initiated in patients with higher frailty severity and ADL dependence; obtaining geriatric impairment information may help prompt ACP discussions.

Prevalence and associated factors of proliferative diabetic retinopathy among adult diabetic patients in Northwest Ethiopia, 2023: A cross-sectional multicenter study.

Proliferative diabetic retinopathy is one of the advanced complications of diabetic retinopathy. If left untreated, almost all eyes could lose a significant portion of their vision within four months. There is limited evidence regarding the magnitude of proliferative diabetic retinopathy and associated factors in the study setting and also in Ethiopia. To determine the magnitude and associated factors of proliferative diabetic retinopathy among adult diabetic patients attending Specialized Comprehensive Hospital-Diabetic Care Clinics in Northwest Ethiopia, 2023. A multicenter, hospital-based, cross-sectional study was conducted on 1219 adult diabetic patients selected by systematic random sampling technique. Data were collected through an in-person interview and physical examination. The Statistical Package for Social Science Version 20 was used to analyze the data. Logistic regression methods were used to test the association between predisposing factors and proliferative diabetic retinopathy. The adjusted odds ratio with a 95% confidence interval was used to determine the strength of association. The prevalence of proliferative diabetic retinopathy was 3.1% (95% CI: 2.10%-4.10%). Hypertension (AOR = 4.35 (95% CI: 1.87-10.12)), peripheral neuropathy (AOR = 3.87 (95% CI: 1.57-9.54)), nephropathy (AOR = 2.58 (95% CI: 1.13-5.87)), ≥10 years duration of diabetes mellitus (AOR = 5.30 (95% CI: 2.32-12.14)), insulin use (AOR = 3.07 (95% CI: 1.08-8.68)), and poor adherence to diabetes mellitus medications (AOR = 3.77 (95% CI: 1.64-8.64)) were confirmed to have statistically significant association with proliferative diabetic retinopathy. The prevalence of proliferative diabetic retinopathy among adult diabetic patients in the diabetes clinic was higher than the global study. Hypertension, peripheral neuropathy, nephropathy, ≥10 year's duration of diabetic mellitus, insulin use and poor adherence to diabetes mellitus medications were among the factors significantly associated with proliferative diabetic retinopathy.

'Suspension Palatoplasty' - A method of surgical correction of VPI post Cleft Palate repair.

To design the technique of 'Suspension Palatoplasty' for Velopharyngeal Insufficiency (VPI) post Cleft Palate (CP) based on optimal spatial positioning of palate at the time of VPI correction, by using a non-obstructive, high, midline pharyngeal flap for predictable velopharyngeal closure and normal speech. To evaluate the results of CP patients with VPI operated using the technique of 'Suspension palatoplasty'. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients operated using the 'Suspension Palatoplasty' technique for VPI post CP repair between 2014 and 2018 with a minimum follow-up period of 5 years. 'Suspension Palatoplasty' - Double Opposing Z (DOZ) plasty with palatal myoplasty is used to revise soft palate and a narrow superiorly based pharyngeal flap is used to suspend it for a dynamic velopharyngeal closure. Speech outcome and surgical complications. 70 out of 119 studied were found to have normal speech (59%), and another 25 patients (21%) had acceptable speech. Thus 95 out of 119 patients (80%) had normal or near-normal speech and did not require any further speech therapy or surgeries. 12 patients had snoring without difficulty in breathing. One patient had symptoms suggestive of obstructive sleep apnea. Younger patients had a higher percentage of normal speech outcomes. Many of our adult patients also attained normal speech. 'Suspension Palatoplasty' aims to achieve normal speech with little effort. It has minimal side effects. The author has performed 403 cases to date.

Diabetes mellitus and associated risk factors among HIV infected patients on HAART

BackgroundUnderstanding the impact of disease associations is becoming a priority in Kenya and other countries bearing the load of infectious diseases. With the increased incidences of non-communicable diseases and the endemicity of infectious diseases in Sub-Saharan Africa, their co-existence poses significant challenges to patients, health workers and an overwhelmed health sector. Classical risk factors for diabetes such as physical inactivity and unhealthy diet may not solely explain the current trends, suggesting the role of novel risk factors including infections/inflammation. HIV and its treatment have been identified as potential contributors especially to patients with family history of confirmed diabetes cases. Co-infections frequently observed during HIV infection also significantly influence both the epidemiological and pathophysiological of the link between HIV and diabetes. Understanding the correlates of HIV and diabetes is crucial to inform management and prevention strategies of the twin infections. We therefore aimed to determine the prevalence of diabetes mellitus and risk factors in a population of HIV infected patients on HAART. This study determined the association of diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a comprehensive care clinic in Nairobi (Kenya). Participants were screened for diabetes and impaired glucose regulation using random blood glucose and glycated haemoglobin (HbA1c) This paper describes the prevalence of diabetes mellitus in Human Immunodeficiency Virus positive individuals and the associated risk factors. We have demonstrated that family history is a risk factor for diabetes. While age and BMI are known risk factors, they were not associated with diabetes in this study.

Missed HIV care appointments and high body mass index predict hypertension risks at diagnosis: a risk identifying opportunity among people living with HIV for global health

Background: Chronic conditions, including diabetes and hypertension among people living with HIV/AIDS (PLWHIV), require long-term adherence to treatment and regular follow-ups for symptom checkups and management to prolong life and improve its quality. To inform the design of patient-centered HIV-NCD interventions, this study determined predictors of hypertension and diabetes (non-communicable diseases-NCD) among PLWHIV. Methods: This study adopted a cross-sectional study design. Attendance registers of PLWHIV attending the comprehensive care clinic at Murang'a referral hospital served as a sampling frame. The first study participant was randomly selected using a lottery method, while other participants were systematically sampled and enrolled. PLWHIV were clinically examined for NCD (hypertension and/or diabetes) screening and body mass index (BMI). Logistic regression models predicted associations with risk factors linked to the selected NCD among PLWHIV. Results: A total of 281 PLWHIV were recruited, of these 192 (68%) were female, while 91% were aged above 35 years. We identified 77 (27%) PLWHIV with hypertension, and none had diabetes. About 70% of the PLWHIV with NCD missed HIV care appointments. About 89% of the PLWHIV were obese and overweight. Higher BMI (Odds ratio (OR)=1.15 95%CI 1.06, 1.24) and missing HIV care appointments (OR=2.12 95%, CI 1.23, 3.95) increased the risk of hypertension among PLWHIV. Conclusions: We establish increased risks to NCD associated with higher BMI and missed scheduled HIV-linked care among PLWHIV. To improve global health, identifying and understanding determinants of missed HIV care appointments will help to re-engage defaulters while promoting regular screening for NCD profiles.

The Influence of HIV/AIDS Care and Support Services Accessibility on Utilization among HIV Infected Adults in Baringo County, Kenya

Context: Globally, efforts are being made to end the HIV/AIDS pandemic and improve the general health of people living with HIV/AIDS through continuous access to care and support services. However, the incidence of dropouts from utilization of HIV care and support services is rising among the HIV-positive clients enrolled in comprehensive care clinics in Baringo County for unidentified reasons. As a result, recognizing the opportunities and challenges in low-resourced communities that must be overcome to promote greater access to care and treatment will influence higher utilization.&#x0D; Aim: This study evaluates the influence of accessibility of HIV/AIDS care and support services on the utilization of HIV-infected adults in Baringo County.&#x0D; Methods: The study was conducted in Baringo County HIV comprehensive care centers. An analytical cross-sectional study design was used with 580 participants recruited. An interviewer-administered questionnaire was used to obtain data.&#x0D; Results: Support from social services (p&lt;0.0001), less frequent visits to clinics less than one month (p&lt;0.0001), access to treatment interventions (p&lt;0.0001), and easily accessible information (p &lt;0.0001) were among the factors associated with good accessibility to HIV services, according to bivariate analysis. Conversely, being an atheist (p&lt;0.006), residing in rural areas (p ≤0.0006), difficulty accessing services (p≤0.0001), and getting to another town (p &lt; 0.03) or getting to another county (p ≤0.0004) were linked to inadequate access to HIV/AIDS care and support services.&#x0D; Conclusion: The findings show that the efforts to support clients' access to HIV/AIDS care and support services should be made in response to their individual needs and consideration of geographical location. Besides, individualized HIV/AIDS services access depends on the support provided, where they are located, easily accessible information about the services, and how frequently they are provided. In contrast, living in rural areas, seeking services in a different town, feeling ashamed to visit clinics, and having a lower CD4 count were all associated with poor accessibility and utilization of HIV/AIDS care and support services. Consequently, it is necessary to establish support initiatives to address any of these access issues that particular clients might have.

Development of specific growth charts for children with Fanconi anemia.

Patients with Fanconi anemia (FA) are often perceived to have poor growth when general population growth curves are utilized. We hypothesize that FA patients have unique growth and aimed to create FA-specific growth charts. Height and weight data from ages 0 to 20 years were extracted from medical records of patients treated at the Fanconi Anemia Comprehensive Care Clinic at the University of Minnesota. Height, weight, and BMI growth curves were generated and fitted to reference percentiles using the Lambda-Mu-Sigma method. FA-specific percentiles were compared to WHO standards for ages 0-2 and CDC references for ages 2-20. In FA males, the 50th height- and weight-for-age percentiles overlap with the 3rd reference percentile. In FA females, only the 50th height-for-age percentile overlaps with the 3rd reference percentile. For weight, FA females show progressive growth failure between 6 and 24 months followed by stabilization around the 50th percentile. The FA BMI-for-age percentiles show similar patterns to the weight-for-age percentiles but have different timing of onset of adiposity rebound and broader variability in females. Growth in FA patients follows a different trajectory than available normative curves. FA-specific growth charts may be useful to better guide accurate growth expectations, evaluations, and treatment.

Factors associated with opportunistic infections (OIs) among HIV/AIDS patients attending comprehensive care clinic (CCC) at Mbagathi District Hospital, Nairobi Kenya: a cross-sectional study

Factors associated with opportunistic infections (OIs) among HIV/AIDS patients attending comprehensive care clinic (CCC) at Mbagathi District Hospital, Nairobi Kenya: a cross-sectional study

'Suspension Palatoplasty' - A new Method of Primary Palate Repair for Speaking Un-Repaired Clefts.

To design a technique of palate repair with predictable Velo Pharyngeal (VP) closure and normal speech - 'Suspension Palatoplasty' in speaking unrepaired Cleft Palate (CP) patients. To evaluate the results of patients with CP operated using the technique of 'Suspension palatoplasty' from 2014 -2018 in terms of surgical complications and speech outcomes. An ambi-spective longitudinal clinical study. Comprehensive cleft care clinic in a private trust hospital. Patients above 6 years of age with isolated CP, cleft lip and palate (CLP), operated using 'Suspension Palatoplasty' technique between 2014 and 2018 were included with minimum follow up period of 5 years. Subjective speech evaluation was done by two speech therapists and analysed. Author designed the technique of 'Suspension Palatoplasty' which aims to suspend the soft palate repaired by 'Hybrid Palatoplasty' technique, close to the nasopharynx using narrow pharyngeal flap with the pedicle based superiorly at adenoids, for an acceptable VP closure. Speech outcome and surgical complications were assessed. Out of 94 cases operated with age ranging from 6 to 45 years, 59 (62.8%) had normal speech, 12 (12.8%) had articulation errors but with no Velo-Pharyngeal Insufficiency (VPI) and 23 patients (24.4%) had hypernasality/ nasal emission (Suspected VPI). None of them had difficulty in breathing but one patient had snoring. 'Suspension Palatoplasty' is a simple primary operation with excellent speech outcomes with no obstructive sequelae in patients with speaking unrepaired cleft palate.

Prevalence of Non-Tuberculosis Mycobacterium Pulmonary Disease in HIV-1 Patients with Presumptive Pulmonary Tuberculosis in Western Kenya.

Non-tuberculous mycobacteria (NTMs) are ubiquitous, free-living, environmental saprophytic microorganisms. NTMs belong to the genus Mycobacterium which includes Mycobacterium tuberculosis (MTB). NTMs have lately been a major cause of pulmonary disease (PD) in immuno-compromised individuals including HIV-1 patients. NTMs and MTB appear similar based on microscopy, radiology, and clinical symptoms; consequently, this may lead to misdiagnosis. This study sought to establish the prevalence of NTM pulmonary disease in HIV-1 patients presumed to have pulmonary tuberculosis. A cross-sectional analytical laboratory study design was used targeting 617 adult HIV-1 infected patients presenting with presumptive pulmonary TB at Bungoma County Hospital Comprehensive Care Clinic in Western Kenya between July 2021 to June 2022. A total of 75 (12.2%, 4.6 -9.8 CI) of the participants presented with presumptive MTB and had TB-like symptoms while 542 (87.8%, 12.5 -30.7 CI) were negative. Additionally, 56 (9.1%) were infected with NTMs. HIV-positive participants had a significantly higher prevalence of NTMs 62 (11.8%, 5.6 -9.2 CI) compared to 2 (2.1%, 0.4 -1.8 CI). In HIV + study participants P<0.0001. M. avium was the most prevalent NTM, 25(33.3%), followed by M. fortuitum 20 (26.7%). A significant number of the isolates were M. tuberculosis 10 (13.3%) as well as M. kansasii 8 (10.7%). There seems to be a high prevalence of NTMPD in HIV-1 patients which is assumed to be pulmonary TB. Differential diagnosis of the mycobacterium species is necessary to help improve disease management and outcomes in this group of patients.

E66 Arthropathy as the initial presentation of HIV

Abstract Background Human immunodeficiency virus (HIV) has been associated with musculoskeletal disorders which has been estimated to occur in 11–72% of infected patients. Most of these reports however have been in adults with few published cases of HIV associated arthritis in children. The articular manifestations of HIV, especially overt arthritis, can occur at any stage of the disease but are more prevalent in advanced immunosuppression. With the increased access to early diagnosis and highly active antiretroviral therapy (HAART), such complications have increasingly become rare. However, HIV diagnosis may often be missed or delayed in slow progressors, and in such circumstances, these patients may manifest with arthritis as the initial manifestation of HIV. Therefore, there’s need for consideration of HIV associated arthritis in children presenting with arthropathy of undetermined cause. We hereby present a case of arthritis as the initial manifestation of HIV in a child with missed diagnosis of HIV. Methodology/case presentation A 12-year-old boy was admitted in the Kenyatta National Hospital (KNH) paediatric ward with a history of joint pain and swelling for three months. He had otherwise previously been well. He had no history of fever, trauma, preceding gastroenteritis or urine tract infection. He had no chorea, no erythematous rash and no cardiac complications of rheumatic fever. He was not wasted, and was able to walk with great difficulty. He had bilateral knee and right ankle swelling. The swollen joints were warm to touch with positive ballotment and fluid sweep test. Joint aspiration revealed straw coloured joint effusion. Investigations included a positive HIV rapid test with CD4% of 6, CRP 8.33 mg/l (n = &amp;lt;5), Elevated ESR (111 mm in first h) and negative ANA. Bilateral Knee -rays did not reveal any destructive or erosive changes. A diagnosis of HIV arthropathy was made and the patient was started on HAART, HCQ, prednisone and ibuprofen. He improved, with resolution of the joint swellings, was discharged home after 10 days and follow up in the rheumatology and comprehensive care clinics advised. Conclusion HIV arthropathy should be considered in patients manifesting with arthritis of unknown origin; and the patients evaluated for HIV as a strategy for identifying and including them in care. Highly active antiretroviral therapy, steroids, hydroxychloroquine and NSAIDS may be effective therapy for HIV arthropathy. Disclosure statement: The authors have no conflict of interest to declare.

Misclassification of Loss to Care Among Persons With Human Immunodeficiency Virus: Improved Capture of Silent Transfers Through Surveillance Linkage Using Statewide Mandatorily Reported Laboratory Measures.

Human Immunodeficiency Virus (HIV)-positive individuals lost to follow-up from particular clinics may not be lost to care (LTC). After linking Vanderbilt's Comprehensive Care Clinic cohort to Tennessee's statewide HIV surveillance database, LTC decreased from 48.4% to 35.0% at 10 years. Routine surveillance linkage by domestic HIV clinics would improve LTC and retention measure accuracy.

Evaluation of dental students' clinical communication skills from three perspective approaches: A cross-sectional study.

The communication skills of clinicians are very crucial in providing better health outcomes for patients. Therefore, this study aimed to assess undergraduate dental students' communication skills in relation to their demographics and clinical setting using a three-perspective approach; the student, the patient and the clinical instructor perspective. A cross-sectional study was conducted using validated modified-communication tools; Patient Communication Assessment Instruments (PCAI), Student Communication Assessment Instruments (SCAI) and Clinical Communication Assessment Instruments (CCAI) which included four communication domains. One hundred and seventy-six undergraduate clinical year students were recruited in this study whereby each of them was assessed by a clinical instructor and a randomly selected patient in two settings: Dental Health Education (DHE) and Comprehensive Care (CC) clinic. Comparing the three perspectives, PCAI yielded the highest scores across all domains, followed by SCAI and CCAI (p < .001). SCAI exhibited a better score in Year 5 compared to Year 3 and Year 4 (p = .027). The male students perceived they performed better than females in all domains (p < .05). Patients rated the students higher in the DHE clinic as compared to the CC clinic for the team interaction domain. There was an upward pattern of the communication skills score rated from the clinical instructor perspective to the student and patient perspectives. The use of PCAI, SCAI and CCAI collectively gave a complementary view of students' communication performance in all the domains assessed.