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Background: Crystal arthropathies represent a heterogeneous group of skeletal (musculo-skeletal) diseases associated with the deposition of mineralized material within joints and periarticular soft tissues. Gout is the most common and pathogenetically best understood crystal arthropathy, followed by basic calcium phosphate and calcium pyrophosphate dihydrate deposition diseases, and, in very rare cases, calcium oxalate crystal arthropathy. In Kenya there are no studies to demonstrate the prevalence of these diseases. This study endeavored to describe the different types of crystals seen in patients with synovitis in Nairobi from 1st January 2012 to 31st January 2014. Objective: To describe different types of crystals seen in patients with synovitis in Nairobi. Design: Descriptive prospective cross sectional study. Results: There were 260 samples received from patients with synovitis. Of them, 61 (23.5%) were from males while 199 (76.5%) were from females. The age range of the patients was from 14 – 110 years. The mean, median and mode were 59.6, 60 and 55 years respectively. Majority of the patients were in the 51-60 years age category. Most of the patients recruited had no crystals (n=211; 81.2%) diagnosed, with 14.2%(n=37) having uric acid crystals and 4.6 % (n=12) having CPPD crystals. For the patients who had uric acid crystals (n=37), when gender was cross tabulated against microscopy, males (n=32; 86.5%) were noted to have more uric acid crystals than females (n=5; 13.5%). Among patients diagnosed with CPPD (n=12), there were more females (n=9; 75%) patients compared to males (n=3; 25%). From the total population recruited (n=260), when age range categories were cross tabulated against microscopy, the age ranges 41-50 (n=9; 3.5%) 51-60 (n=12; 4.6%), and 61-70 (n=6; 2.3%) were noted to have more uric acid crystals than any other age category recruited. Patients in the age category 61-70 (n=6; 50 %) had more CPPD crystal detections than any other age category from the patients recruited. Conclusion: Crystal arthropathy is a major cause of synovitis in patients seen in Nairobi.

Background: Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The exact prevalence isn’t known but some studies have reported between 0.85 – 3%, and appears to be more common in African population. Patients with DILS tend to have higher CD4 cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Common sites of extra glandular involvement are the lungs being the most common site, followed by peripheral neuropathy and liver. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. Objective: To review pathogenesis, diagnostic approach and current trends in the management of diffuse interstitial lymphocytic syndrome. Data source: Literature review of relevant published literature from both Africa and the rest of the world. Data synthesis: Pathologically, under light microscopy, DILS resembles the focal sialadenitis seen with Sjogren’s syndrome, although it tends to be less destructive of the glandular architecture than in Sjogren’s syndrome. Most of the inflammatory infiltrate is composed of CD8+ lymphocytes unlike Sjogren’s which are CD4+. Lymphoepithelial cysts are frequently observed in the parotid glands of patients with DILS. The variation in CD8+ count in the course of HIV disease is less understood. The variation in CD8+ lymphocytes is implicated in the pathogenesis of a number of clinical manifestations in HIV diseases including Diffuse Infiltrative Lymphocytic Syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome. Parotid gland enlargement in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware that the pulmonary process associated with DILS may mimic clinically and radiographically the pneumonic process caused by pneumocystis carinii. Other manifestations of DILS to consider include a severe form of peripheral neuropathy; lymphocytic infiltration of the liver, evident as hepatitis; myositis; and lymphocytic interstitial nephritis. Management of DILS is determined by the severity of glandular and extra glandular features. Data on therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy. Conclusion: DILS, a subset of HIV disease manifestation, may present as parotid gland swellings. In general, an HIV patient presenting with DILS has a better prognosis than a patient with HIV alone. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. Clinicians should watch for the possible transformation into B-cell lymphoma. There is still paucity of data about this disease from pathophysiology to treatment to studies correlating the plasma viral load with CD8+ lymphocyte count in patients with HIV disease.

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Background: Health related quality of life is increasingly being recognised as a primary outcome measure in treatment of end-stage renal disease. The health related quality of life of patients on maintenance haemodialysis is reduced. Several interventions directed at modifiable risk factors have been shown to improve quality of life of patients on haemodialysis.Objective: To assess the health-related quality of life of patients on maintenance haemodialysis at the Kenyatta National Hospital.Design: Cross sectional descriptive study.Setting: Kenyatta National Hospital, Renal Unit.Subjects: The study was conducted on 96 patients with end-stage renal disease on maintenance haemodialysis. Socio-demographic and clinical factors were recorded for all patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life-36 questionnaire. Two summary scores and three subscale scores were calculated.Results: The mean physical composite summary and mental composite summary scores were 39.09±9.49 and 41.87±10.56 respectively. The burden of kidney disease subscale, symptom and problems subscale and effect of kidney disease on daily life subscale scores were 16.15±21.83, 73.46±18.061 and 67.63±23.45 respectively.Conclusion: Health-related quality of life of patients on maintenance haemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. The burden of kidney disease subscale is the most affected subscale score.