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Optimal initial PEEP in management of preterm infant with respiratory distress syndrome: a prospective study at newborn unit of Moi Teaching and Referral Hospital

Mon, 01 Jan 2024 00:00:00 GMT

Title: Optimal initial PEEP in management of preterm infant with respiratory distress syndrome: a prospective study at newborn unit of Moi Teaching and Referral Hospital Authors: Vulalo, Deborah Makasi; Mwangi, Ann; Chepkemoi, Audrey K.; Amubuomombe, Philippe Poli; Ayaya, Samuel O Abstract: Background: Respiratory distress syndrome remains an important cause of 22 neonatal mortality and morbidity worldwide. Early initiation of continuous 23 positive airway pressure is a standard of care for preterm infants with 24 respiratory distress syndrome. Positive end-expiratory pressure reduces the ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTICLE IN PRESS2 25 need for invasive ventilation and prevents chronic lung disease. However, 26 the optimum positive end expiratory pressure level to effectively treat 27 respiratory distress syndrome in preterm infants remains unknown. 28 Objective: To determine the optimal initial positive end expiratory pressure 29 level in management of preterm infants with respiratory distress syndrome. 30 Methods: This prospective descriptive study was conducted from July 2023 31 to January 2024 in the newborn unit of Moi Teaching and Referral Hospital. 32 A total of 204 preterm infants (28-34 weeks gestational age) with 33 respiratory distress syndrome who required Continuous Positive Airway 34 Pressure treatment were recruited. Data on the maternal and neonatal 35 characteristics, low and high positive end expiratory pressure levels, and 36 outcomes at 72 hours were collected and analysed. Descriptive statistics 37 were used for continuous variables, and frequencies were used for 38 categorical data. A p value less than 0.05 was considered statistically 39 significant at the 95% confidence interval. Receiver operating characteristic 40 curves were used to determine the optimal positive end expiratory pressure 41 level. 42 Results: A total of 45 and 159 preterm infants were started on low and high 43 positive end expiratory pressure levels, respectively. Among 159 (77.9%) of 44 the preterm infants started on high positive end expiratory pressure levels, 45 majority (135, 66.2%) were initiated at a positive end expiratory pressure 46 level of 6 cmH2O. The Area under the curve for low positive end expiratory ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTICLE IN PRESS3 47 pressure levels was 0.5757 and the one for high positive end expiratory 48 pressure levels was 0.5405. DeLong's test for two ROC curves D = 0.82979, 49 df = 120.8, p value = 0.4083. The area under the curve of both low and high 50 positive end expiratory pressure levels were close and not significantly 51 different (p=0.4083). 52 Conclusion: In this study, low positive end expiratory pressure was 53 associated with low failure rate and complications. However low and high 54 positive end expiratory pressure levels were not significantly different to 55 determine the optimal initial PEEP. Further research are needed to 56 determine optimal PEEP for continuous positive airway pressure initiation 57 in preterm infants with respiratory distress syndrome

Radiological Morphometry of the Proximal Femur in Kenyan Adult Patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Title: Radiological Morphometry of the Proximal Femur in Kenyan Adult Patients at Moi Teaching and Referral Hospital, Eldoret, Kenya Authors: Ambuka, Darwin; Ramadhani, Ayumba Barry; Njoroge, Antony N. Abstract: Background: The prevalence of proximal femur and hip ailments is increasing, requiring appropriate treatments such as osteosynthesis and arthroplasty. Preoperative planning relies on morphometric dimensions of the proximal femur, yet anatomical variations across populations mean many commercial implants may not fit optimally. Selecting the correct implant is crucial to avoid postoperative complications, hence the need for this study. Objectives: To determine the radiomorphometric measurements of the neck-shaft angle (NSA) and femoral head diameter (FHD) in Kenyan adults at Moi Teaching and Referral Hospital (MTRH) to guide implant design and assess variations by gender, laterality, and influencing factors. Methods: A cross-sectional survey was done on 118 normal radiograph patients comprising of 57 (48.3%) males and 61 (51.7%) females. Student-t-test was used to compare the measurements of the proximal femur in relation to gender and laterality. Statistical significance was determined by a p-value less than 0.05. Continuous data was presented as mean, standard deviation, median, interquartile range, while categorical data as frequency and proportions. Results: Results reveal that, for factors affecting NSA and FHD, Age (p-value 0.911), Gender (p-value 0.643), Region (p-value 0.449) and Level of activity (p-value 0.498) did not have statistical significance on the findings while Diet (p-value 0.029) was statistically significant. Majority of patents were of middle age. The mean Femoral NSA and FHD diameter in Kenyan adult patients varied from those of other populations. The mean NSA and FHD varied in relation to gender (males greater) and laterality (right greater, but difference not statistically significant) in terms of measurements. Diet factor finding was statistically significant. Conclusion and Recommendations: Implants should be designed according to the new measurements in this study. Orthopaedic Surgeons should always consider morphometric dimensions before osteosynthesis in the proximal femur and arthroplasty of the hip.

Disability, Ability and Productivity: A Personal Experience in Moi University

Sat, 01 May 2021 00:00:00 GMT

Title: Disability, Ability and Productivity: A Personal Experience in Moi University Authors: Yungungu, Alice Abstract: Kenya’s 2019 census report indicated that 0.9 (2.2%) million people of the country’s population are disabled with at least 36% having visual, hearing, and cognition impairments. However, lack of rehabilitation therapies, limited access to education and socio-economic limitations have often prevented the disabled from receiving equal opportunities to fully participate in the country’s workforce. Environment is a key factor in human development. It is even more so to a physically challenged person. As a Bachelor, Masters and Doctorate student with visual impairment at Moi University, I sought to look at the environmental circumstances in the institution and how they influenced my self-driven character and unquenchable thirst for success. This article is therefore based on experiential explanation. It is based on my own experiences as a student with visual impairment. The paper unveils how disability combined with unfriendly environmental circumstances, motivated me to develop a positive attitude towards life. Possible solutions to these circumstances that were put in place by Moi University making me a strong inspiration in my academic and social success will be discussed. The paper further makes recommendations on how Moi University can create an enabling environment not only for the ordinary, but also with particular interest for the visually impaired students. It is hoped that awareness created through this paper will encourage Moi University and other institutions of higher learning to create a more conducive learning environment for the visually impaired students. This will enable such students to unwrap their hidden potentials knowing that disability is not inability.

Effect of Terms of Service on Career Development in the County Government of Kajiado, Kenya

Thu, 01 Aug 2024 00:00:00 GMT

Title: Effect of Terms of Service on Career Development in the County Government of Kajiado, Kenya Authors: Tapatayia, Lynet; Kwonyike, Joshua; Limo, Patrick Abstract: Employees are major assets of any organization; they play an active role towards Company as well County Governments success and therefore, effective training becomes imperative in order to maximize the job performance. The absence of career development structures can lead to reduced motivation, productivity, and job satisfaction among employees in the workplace. The purpose of these study therefore was to determine the effect of terms of service on career development in the County Government of Kajiado, Kenya. The study was guided by Super’s Theory of Career Development. This study adopted explanatory research design. The target population for the study was 349 respondents. The sample size was 186 respondents. Stratified random sampling was used to select the respondents to participate in the study. The study used questionnaires to collect data. Data was analysed using both descriptive and inferential statistics. Descriptive statistics was frequency, percentages, means and standard deviations. Inferential statistic was simple linear regression model. The study findings showed that terms of services had a positive and significant effect on career development (?= ? .523=., p=0.000<0.05). The study concluded that there was a positive and significant effect of terms of services on career development. The importance of clear career paths, progression opportunities, and fair compensation was highlighted, emphasizing the role of well-crafted terms of service in fostering a conducive environment for professional growth. The study recommended that conduct a thorough review of existing terms of service to identify and address any elements hindering career development in the County Government of Kajiado and establish transparent and easily understandable terms to promote clarity and reduce ambiguity.