Developing human rights competencies for South African health professional graduates.

Human rights are social or material entitlements which are recognised universally in national and international law and that address fundamental human needs. They inhere in all people by virtue of their humanity, and represent a standard to which governments can be held accountable

Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome

The association of paraneoplastic hypoglycemia [Doege-Potter syndrome] and finger clubbing [Pierre-Marie-Bamberg syndrome] with pleural solitary fibrous tumour is rare. We present a previously unpublished but typical example of this rare occurrence together with a detailed updated literature review of previously published cases of pleural SFT discussing the histopathology of SFT; pathophysiology of the hypoglycemia and finger clubbing; treatment and outcome of pleural SFT. The patient, a 57-year-old African male was admitted at our hospital with recurrent episodes of hypoglycemia. He was found to have digital clubbing and decreased breath sounds in the right lower chest but no other significant clinical findings. His insulin level measured during an episode of hypoglycemia was undetectable. Chest radiograph and CT-scan revealed a lobulated mass in the right chest which was diagnosed to be SFT on histology. Surgical excision of the mass resulted in cure of the hypoglycemic episodes and rapid regression of the clubbing. Less than 65 cases of pleural SFT manifesting with hypoglycemia with or without finger-clubbing have been published in the English literature. The mean diameter of these tumours manifesting with hypoglycemia is 20 cm, 54% being benign while 42% were malignant. They predominantly present in the 6th-8th decade, average age of 64 years and a slight male preponderance at 58%. Complete surgical resection remains the most important predictor of clinical outcome in terms of recurrence and metastases, while providing instant cure for the hypoglycemia and rapid resolution of the finger clubbing

Utility of p16INK4a expression for the interpretation of uterine cervical biopsies in Kenya

Introduction: histologic interpretation of hematoxylin and eosin-stained cervical biopsies is subject to substantial discordance among pathologists. Immunohistochemical staining for p16INK4a can reduce inter-observer disagreement. We did a cross-sectional study to evaluate the utility of p16INK4a staining in the assessment of cervical biopsies in Nairobi, Kenya. Methods: hematoxylin and eosin-stained sections from 91 colposcopic biopsies diagnosed as negative for dysplasia or as cervical intraepithelial neoplasia (CIN) grade 1-3 from 2011-2013 in Nairobi, Kenya, were reviewed and immunostained for p16INK4a. Agreement in interpretation of cervical biopsies was compared between primary and consensus review results. Results: on primary evaluation, 16 cases were negative for squamous dysplasia; 23 were CIN 1; 37 CIN 2; and 15 CIN 3. On consensus review, 32 cases were negative for dysplasia; 19 were CIN 1; 16 CIN 2 and 24 CIN 3. Agreement was moderate between primary and consensus histology review results for the diagnosis of low-grade versus high-grade squamous intraepithelial lesions (Kappa = 0.568). None of the cases negative for dysplasia were positive for p16INK4a expression, but in primary and consensus review results, 17% and 5% cases of CIN 1; 49% and 69% of CIN 2, and 80% and 96% of CIN 3 were p16INK4a positive, respectively. Conclusion: there was significant variability in the interpretation of cervical biopsies on hematoxylin and eosin between primary and consensus review assessments. 75% of CIN 1 cases that were upgraded to CIN 2 during consensus review expressed p16INK4a. These findings demonstrate the role of p16INK4a in increasing diagnostic accuracy and as a marker of high-grade CIN 2/3

Health effects of lead exposure among Jua Kali (informal sector) workers in Mombasa, Kenya: A case study of the "Express" Jua Kali workers

The objective of this study is to analyze the effects of lead exposure among the Jua Kali workers. Correlation study: relationship between lead exposure and its effects on blood lead levels (BLL), kidney function and haemoglobin levels between the lead-exposed versus the lead un-exposed workers. 162 adult Jua Kali workers participated. Out of 119 exposed workers, 8 (6.72%) were aware of lead while only 3 of them (2.5%) used protective equipment. The highest BLL in the test group was 32 μg/dl with 16 of them (13.45%) having BLL above 10 μg/dl. The mean BLL in this group was 6.76 ± 5.96. In the control group, the highest BLL was 9 μg/dl with none having BLL above10 μg/dl. The mean BLL was 2.58 ± 1.69. The spearman's correlation coefficient was 0.272 significant at 0.05 level. 14 out of 119 (13.45%) exposed workers had impaired glomerular filtration rates (GFR). The mean GFR in the exposed workers was 104.85 ± 16.485. In the un-exposed workers, 1 out of 43 (2.4%) had impaired GFR. The mean GFR was 109.98 ± 15.408. The spearman's correlation coefficient was -0.113, not statistically significant. 21 out of 119 (17.6%) lead-exposed workers had haemoglobin (HB) less than 13 g/dl with mean HB of 14.12 ± 1.600. 1 out 43 (2.3%) in the control group had an HB of less than 13 g/dl with the mean HB of 14.37 ± 1.34. Spearman's correlation coefficient of negative 0.321 (P<0.05) implying significant inverse relationship. Recommendations: education on lead and its effects, provision of protective equipments, medical facilities to diagnose and manage lead and other heavy metal toxicity