Brian Kariuki - Academia.edu (original) (raw)

Papers by Brian Kariuki

The Annals of African Surgery, Sep 2, 2022

Anatomy Journal of Africa, 1970

Morphometric properties of the gallbladder such as length, diameter and volume are determinants o... more Morphometric properties of the gallbladder such as length, diameter and volume are determinants of gallbladder function. These parameters are altered with age and may explain the age-related reduction in gallbladder contractility associated with gallstone formation. Ninety-two gallbladder specimens of subjects aged between 21 and 84 were sourced from City mortuary and the Department of Human anatomy during autopsy. For each gallbladder specimen, measurements of length and circumference were taken to the accuracy of 0.1millimetres (mm) and used to calculate the gallbladder volume. These measurements were standardized using measurements of liver length and weight. Data were recorded by age categories in age groups of 21-30, 31-40, 41-50, 51-60 and 61 or more years. The mean gallbladder volume was 47.948 (±19.080) cm3 and showed a statistically significant increase with age (p <0.001). There was also a significant increase of gallbladder length (p =0.01) and diameter (p <0.001). ...

$Research paper thumbnail of Delays in hospital admissions in patients with fractures across 18 low-income and middle-income countries (INORMUS): a prospective observational study$

The Lancet Global Health, 2020

Background The Lancet Commission on Global Surgery established the Three Delays framework, catego... more Background The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. Methods In this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays (delays in reaching care) were the least common (423 [5•4%]). Compared with other methods of transportation (eg, walking, rickshaw), ambulances led to delay in transporting patients with open fractures to a treating hospital (adjusted RR 0•66, 99% CI 0•46-0•93). Compared with patients with closed lower limb fractures, patients with closed spine (adjusted RR 2•47, 99% CI 2•17-2•81) and pelvic (1•35, 1•10-1•66) fractures were most likely to have delays of more than 24 h before admission to hospital. Interpretation In low-income and middle-income countries, timely hospital admission remains largely inaccessible, especially among patients with open fractures. Reducing hospital-based delays in receiving care, and, in particular, improving interfacility referral systems are the most substantial tools for reducing delays in admissions to hospital.

Pan African Medical Journal, 2020

Malawi Medical Journal, 2019

Background The pattern of stroke in rural population differs from that in urban ones. Although th... more Background The pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital. Patients and Methods The study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts. Results Out of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32-96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%). Conclusion Ischaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population.

Annals of African Surgery, 2019

Craniomaxillofacial Trauma & Reconstruction, 2017

Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to... more Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (± 5.99) mm and 15.19 (± 6.68) mm, respectively. The point where it crossed the ICA was 12.24 (± 3.71) mm superior to the greater horn of hyoid, 17.16 (± 4.40) mm inferior to the angle of the mandible, and 39.08 (± 5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study ...

MOJ Anatomy & Physiology, 2017

Even though the PV is described to originate posterior to the neck of the pancreas [1], pre pancr... more Even though the PV is described to originate posterior to the neck of the pancreas [1], pre pancreatic origins have been described [10]. Furthermore, there is barely scientific literature detailing the location of the PV relative to the neck of the pancreas. The aim of this study therefore was to describe variations in the formation of the PV in a Kenyan population. Methods The present study was carried out during routine dissection in the Department of Human Anatomy, University of Nairobi. A total of 42 adult cadavers (27 male and 15 female) were included in this study. Cadavers that had features of previous abdominal surgeries or trauma were excluded from the study. After a midline abdominal incision to open the abdomen was made, the SMV, IMV and SV were identified and followed up to the point of PV was formation. Photographs of the variations noted were taken.