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Kenya is rapidly urbanizing at an annual rate of about 4.3%. One of the consequences of urbanization has been the problem of food insecurity in peri-urban areas. Increased migration to urban from rural areas has enhanced food insecurity in these areas. The peri-urban area of Kangundo-Tala in Machakos County is one of the fastest-growing peri-urban areas due to its proximity to the capital city of Nairobi. This study investigated the impact of home gardening in enhancing food security in the rapidly urbanizing middle-income Kangundo–Tala peri-urban areas of Machakos County, Kenya. The specific objectives of the study were: to identify the causes of households’ food insecurity in the study area; to examine the factors influencing the adoption of home gardening and; to establish the role of home gardening as a measure of households’ food security. To measure food security, three consumption behaviors were analyzed: consumption changes, food expenditure reduction and income expansion. A qualitative approach was adopted where a total of 120 newly settled households were interviewed. The three main causes of food insecurity were identified (i) small land sizes, (ii) low and erratic rainfall and, (iii) the socialization of peri-urban dwellers. About 68% of the households were practicing at least one form of home gardening. The need for safe and nutritious food, seasonal unavailability, and inaccessibility of food encouraged the establishment of home gardens. From the gardens, households were able to diversify their diets, access safe food and have food readily available. With enhanced stability in food availability, accessibility, and utilization, the study concluded that home gardens played a major role in enhancing food. However, the production was at a very small scale. Up-scaling of home gardening by the Ministry of Agriculture through training was recommended.

In semi-arid rural Kenya, most households travel long distances to access food markets. This has negative effects on food consumption and the use of market facilities. Over70 % of farmers in Tharaka Constituency lack access to formal markets often relying on contracted middlemen who buy at farm gate for traders in major urban centres. Studies on intra-variation in accessibility to market services remains scanty, yet market purchases account for most food consumed across urban and rural areas. Distance defines accessibility and performance of market facilities in most areas where food insecurity and malnutrition are common. This study used Geographic Information Systems (GIS) to measure physical accessibility to open air markets within semi-arid Tharaka, a constituency where vulnerability to acute food shortage is comparatively high. Normative, administrative and geospatial datasets were used in the analysis. Results showed that geographic accessibility to local market centres vary spatially across the villages. In terms of market accessibility, 40.4% of the total population live in areas with high inaccessibility risks while 36.1% are found in places with low inaccessibility risks and only 23.5% of the population exists in areas with moderate inaccessibility risks. This means a large proportion of deprived population live in villages within high to very high inaccessibility risk areas. This spatial inequity has implications on household food security and explains the chronic problems of hunger and malnutrition experienced in the area. Therefore, markets within high inaccessibility risk areas should be upgraded and infrastructure thereof improved to enable food mobility across these areas.

Food waste occurs when food is ready for consumption but not consumed. Food waste has considerable social, economic and environmental impacts. Even though it has become a global concern, no comprehensive studies on food waste in Kenya is available. This study sought to establish the sociodemographic determinants of households’ food waste in Garissa sub-county, in Garissa County, Kenya. A total of 165 consumers were involved in the study. Bakery products were the most wasted. The per capita food wasted was 6.1 kg/person/year or approximately 5.1 tonnes (equivalent to 39,352,110 Kcal) for Garissa County. At a per capita consumption of 2360 Kcal/ person/day, the food wasted was enough to feed 16,674 people for one day. Males were more wasteful than females. Food waste was higher in households: headed by people aged 25 – 34 years; with higher income; with urban residency and with large sizes. Annually, Kshs 9600 (US$96) per household was lost from the wasted food translating to a loss of Kshs 1.4 billion (US$ 13.6 million) from the 141,353 households in Garissa County. With guidance and good policies, food waste can be managed since the majority of the consumers were concerned about food waste and had intentions to reduce it.

A 65-year-old male presented to our dermatology clinic with a two-day intensely pruritic rash covering his back. The lesions were predominantly on his chest, upper extremity, and back. He denied any prior history of similar rashes and his past medical history was non-contributory. A detailed exposure history revealed the patient had eaten Shiitake mushrooms for dinner 48 hours previously. Physical examination showed a truncal dominant rash. Close-up examination confirmed the papulovesicular nature of the rash with multiple small vesicles grouped both along the breadth and length of each linear streak on an erythematous background. Biopsies showed spongiosis with micro-vesiculation. Blood work showed a nominal CBC and CRP/ESR and serum IgE. The patient was put on topical steroid and the rash resolved in one week. With increasing mushroom consumption [1], cognizance of this etiology avoids a diagnostic ‘odyssey’ and prevents recurrence of this very characteristic rash.

The increasing prevalence of high-risk human papillomavirus (HR-HPV)-associated head and neck squamous cell carcinoma (HNSCC) has prompted strong clinical demands for detecting HR-HPV directly in the tumor. Although p16 immunohistochemistry (IHC) has been the standard testing method, it has limitations including false positivity, lack of sensitivity in low tumor cell samples such as fine-needle aspirate (FNA), and its subjectivity. We developed a modified method based on a commercial automated HR-HPV PCR assay and evaluated the performance characteristics and the diagnostic utility of this assay for direct HR-HPV detection in the HNSCC samples. HNSCC formalin-fixed, paraffin-embedded blocks were retrieved from archives including 44 excisions, 63 biopsies, and 16 FNAs. Tissue slices were trimmed from the blocks, deparaffinized, lysed, and loaded on the commercial automated platform for HR-HPV PCR. All specimens had a concurrent p16 IHC performed. The PCR assay showed high concordance with the p16 IHC (96%; 99/103) and excellent positive agreement (91.5%) and negative agreement (100%). In addition, the PCR assay provided more conclusive results in samples with equivocal p16 IHC results. The modified commercial automated HR-HPV PCR test is a labor-efficient, quick, reliable, sensitive, and specific method for detecting HR-HPV in formalin-fixed, paraffin-embedded samples. This assay also showed excellent diagnostic utility in samples with equivocal p16 IHC results, including FNA cell blocks.

Pediatric chronic myelogenous leukemia is uncommon. We report a pediatric patient with chronic myelogenous leukemia presenting with a normal white blood cell count and no circulating immature myeloid cells. The patient presented with extreme thrombocytosis (platelet count range: 2175–3064 × 109/L) noted incidentally. No splenomegaly was found. Examination of the bone marrow aspirate revealed normal cellularity and normal myeloid: erythroid ratio with marked megakaryocytic hyperplasia. Molecular studies on the bone marrow aspirate detected both the major BCR/ABL1 p210 fusion transcript (9280 copies; p210/ ABL1 ratio: 38.2%) and the minor p190 transcript (below limit of quantitation). The platelet count normalized within 2 weeks after treatment with the second-generation tyrosine kinase inhibitor dasatinib. Follow-up after 3 months revealed a 1.87 log reduction in p210 transcripts compared to diagnosis and no detectable p190 transcripts. This case highlights the need to include BCR/ABL1 fusion testing to accurately diagnose pediatric patients presenting with isolated thrombocytosis.

Kenya is an agri-based economy that heavily relies on rainfall performance. Unfortunately, changes in rainfall patterns have threatened the agricultural sector since it is largely rain-fed. The frequent occurrence and increased severity of climatic extremes, particularly droughts and floods, have led to slow economic development in the affected areas. However, the impacts on the economy vary from one hydrometeorological disaster to the other depending on their characteristics. From the case studies of Laikipia and Bunyala sub- counties in Kenya, the study established an increasing trend in both the frequency and magnitude of floods and droughts. Prolonged and severe flood and drought events had adverse impacts on economic development through (a) decrease in agricultural production, (b) poor prices for livestock and agricultural produce and (c) destruction of the immediate environment which in turn exacerbate the impacts. An inverse relationship between economic development and the magnitude of the disaster was established. The consequence have been increased poverty levels in the areas due to slow economic development.

Agriculture supports up to 75% of the Kenyan population and generates almost all the country’s food requirements. However drought are the major constraints to rain-fed agricultural production, especially in arid and semi arid lands (ASALs) of Kenya which form about 88% of the country. In the last 100 years, Kenya has recorded 28 droughts, three of them in the last decade. The frequency and severity of droughts seems to be increasing in the country over time. The result has been total crop failures and livestock deaths triggering severe food shortages in the country and more specifically in ASAL districts. Between 1993 to date, the government of Kenya has declared 7 national disasters out of which 5 were drought related. These declarations followed the droughts of 1992-93, 1996-97, 1999-2000, 2005-06 and 2008-09 when the Kenya government requested international communities for food aid. About 28 ASAL districts in Kenya have been placed under Emergency Operation Programme (EMOP) due to the heightening food insecurity caused by droughts. This paper highlights the effects of drought on food security in Kenya with special reference to Central and Mukogodo Divisions of the semi arid areas of Laikipia District, Kenya.

The present paper examines the changing climatic scenarios and associated effects on livestock farming (pastoralism) in the arid and semi arid lands (ASAL) of Kenya, which cover over 80% of the country. The study was carried out in the semi arid Mukogodo Division of Laikipia District in Kenya. This division received a mean annual rainfall of approximately 507.8 mm and the main source of livelihood was pastoralism. Questionnaire, structured interview, observation and literature review were the main methods of data collection. Rainfall was used in delineating changes in climate. Standardized precipitation index (SPI) and Markov process were used in analyzing drought severity and persistence, respectively. Approximately 38% of all droughts between 1975 and 2005 were prolonged and extremely severe, with cumulative severity indices ranging between −2.54 and −6.49. The probability that normal climatic conditions persisted for two or more consecutive years in Mukogodo Division remained constant at approximately 52%. However, the probability of wet years persisting for two or more years showed a declining trend, while persistence of dry years increased with duration. A drying climatic trend was established. This drying trend in the area led to increased land degradation and encroachment of invasive nonpalatable bushes. The net effect on pastoralism was large-scale livestock loss through starvation, disease and cattle rustling. Proper drought monitoring and accurate forecasts, community participation in all government interventions, infrastructural development in the ASAL and allocation of adequate resources for livestock development are some of the measures necessary for mitigating the dwindling pastoral economy in Kenya and other parts of the world.

Rosai-Dorfman disease (RDD) was first reported in 1969 as a are, definitive histiocytic disorder which involves overproduction f a non-Langerhans sinus histiocyte. Most often, the abundance f histiocytes leads to massive lymphadenopathy, leading to the lternative nomenclature of sinus histiocytosis with massive lymhadenopathy (SHML). Histologically it is characterized as sinus istiocytosis with emperipolesis. Emperipolesis, which is the presnce of intact lymphocytes within the cytoplasm of a histiocyte, s opposed to phagocytosis of lymphocytes by a histiocyte, is haracteristic but not pathognomonic of RDD [1]. Patients usually resent in their twenties with cervical lymphadenopathy, fever and eukocytosis. Although lymph nodes are most often involved in DD, extranodal involvement to the soft tissue and central nerous system among others, have been reported [1,2]. Often times ases may mimic metastatic disease as multiple lesions may be een. Cases of CNS involvement in the absence of systemic disase or lymphadenopathy are rare. Most often these spinal masses resent with myelopathy, paresis and plegia [3,4]. Our case report s unique in that the patient presented with cervical sensory adiculopathy and symptoms typical for herniated disc/foraminal tenosis.

Farmers in Laikipia East District of Kenya rely on subsistence agriculture as their livelihood source which in turn depends on the amount and distribution of rainfall. The main growing season occur during the peak rainfall season, that is, between March and May while the secondary growing season occurs between October and December. Annual rainfall trend between 1976 and 2005 showed that rainfall in Laikipia East District increased a condition suitable for the good subsistence agricultural performance. On contrary, subsistence agriculture in the district performed dismally. This was caused by changing rainfall patterns. The annual numbers of rain days declined but the intensity of rain increased. During the main growing season, the number of rain days declined in March and May but remained constant in April. Rainfall intensities declined in March but increased in April and May. The effect of the changing pattern in rainfall on subsistence agriculture was evidenced by decreased growing period and ineffective rainfall with overall negative effects on yields. This paper examines the changing pattern of rainfall and the associated impact on subsistence agriculture in Laikipia East District, Kenya. Key words: Climate change, rainfall patterns, growing seasons, subsistence agriculture.

Background: Type 2 diabetes is a heterogeneous disease with multiple causes revolving around beta cell dysfunction, insulin resistance and enhanced hepatic glucose output. Clinical judgement based on obesity status, age of onset and the clinical perception of residual beta cell insulin secretory function (hence insulin-requiring or not), has been used to determine therapeutic choices for each patient. Further laboratory testing of the clinically defined type 2 diabetes unmasks the various aetiologic types within the single clinical group. Objective: To determine the aetiological types of the clinically defined type 2 diabetic patients, their chosen therapies at recruitment and the quality of glycaemic control achieved. Design: Descriptive cross-sectional study. Setting: Diabetes out-patient clinic of Kenyatta National Hospital, Nairobi, Kenya. Results: A total of 124 patients with clinical type 2 diabetes were included, 49.2% were males. The mean duration of diabetes in males was 26.09 (20.95) months and that of females was 28.68 (20.54) months. The aetiological grouping revealed the following proportions: Type 1A-3.2%, Type lB-12.1%, LADA-5.7%, and OtrueO type 2 diabetes 79.0%. All the patients with Type lA were apparently, and rightly so, on Oinsulin-onlyO treatment even though they did not achieve optimal glycaemic control with HbAIc % = 9.06. However the study patients who were type lB and LADA were distributed all over the treatment groups where most of them did not achieve optimal glycaemic control, range of HbAIc of 8.46 -10.6%. The patients with OtrueO type 2 were also distributed all over the treatment groups where only subjects on Odiet onlyO treatment had good HbAIc of 6.72% but those in other treatment groups did not achieve optimal glycaemic control of HbA1c, 8.07 - 9.32%. Conclusion: Type 2 diabetes is a heterogeneous disease where clinical judgement alone does not adequately tell the various aetiological types apart without additional laboratory testing of C-peptide levels and GAD antibody status. This may partly explain the inappropriate treatment choices for the various aetiological types with consequent sub-optimal glycaemic control of those patients.

Background: RUNX2, a member of the RUNX family of transcription factors, regulates normal bone, cartilage and skeletal muscle morphogenesis. Aberrant RUNX2 expression has correlated with malignant cell migration, invasion and bone metastases. In the following study, we evaluated the prognostic significance of RUNX2 protein expression in a large cohort of tumors from each of three sites of origin - prostate, colon and breast. Design: Formalin-fixed paraffin-embedded tissue sections from 121 PAC, 104 CRC and 82 invasive BC [64 ductal (IDC); 18 lobular (ILC)] were immunostained by a manual method (DAKO LSAB+ System-HRP) using mouse monoclonal RUNX2 (Santa Cruz). Nuclear and/or cytoplasmic immunoreactivity was scored based on intensity and percentage of positive cells in both the tumor (T) and adjacent benign (B) epithelium in each case. Cases were assessed as tumor>benign (T>B), tumor = benign (T = B), tumor Results: RUNX2 immunoreactivity was predominately nuclear in PAC, CRC and BC and noted as follows: in PACs: T>B 58%, T = B 31%, T = Gleason grade 7] vs low [< = Gleason grade 6] tumor grade (p = 0.001), advanced [stage III, IV] vs early [stage I, II] tumor stage (p = 0.039) and biochemical disease recurrence (p = 0.008). In CRCs, immunoreactivity was noted as: T>B 61%, T = B 22%, TB 65% and T = B 35%; and correlated overall with early [stage I, II] vs advanced [stage III, IV] tumor stage (p = 0.05); ER positive status (p = 0.028); and on Cox univariate analysis, correlated with both lengthened recurrence free (p = 0.033) and overall (p = 0.042) survival; and showed a trend toward association with PR positive status (p = 0.075). Within the ER negative BC subgroup, RUNX2 immunoreactivity correlated with early tumor stage (p = 0.008) and PR positive status (p = 0.033). Conclusion: While RUNX2 protein expression correlates with adverse prognostic variables in prostate and colon cancers, RUNX2 immunoreactivity portends favorable prognosis in breast cancer. Further study of RUNX2 expression and its potential role as a therapeutic target particularly in PAC and CRC appear warranted. Citation Format: Bhaskar V.S. Kallakury, Albert Huho, Ann B. Boguniewicz, David M. Jones, Tipu Nazeer, Hwa Jeong Lee, Christine E. Sheehan, Jeffrey S. Ross. Prognostic significance of RUNX2 protein expression in carcinomas of the prostate (PAC), colon (CRC), and breast (BC). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4355. doi:10.1158/1538-7445.AM2015-4355