Risk Factors for Esophageal Squamous Cell Carcinoma in a Kenyan Population

Background: Esophageal squamous cell carcinoma (ESCC) is common in some parts of Kenya. Both the regional factors associated with ESCC in  Kenya and geographic distribution has not been completely described. Methods: We analyzed the association of ESCC with smoking, khat  chewing, alcohol, diet, socioeconomic status, caustic ingestion and firstdegree family history of ESCC in a multi-center based matched case-control study. We also determined the geographic origin, age, gender and ethnicity of patients visiting the participating centers between August 2008 and April 2009. Results: Eighty three cases and 166 controls matched for age and gender were studied. The male to female ratio of cases was 2.1:1, majority were from Central and Eastern provinces of Kenya, about one fifth (19%) were younger than 45 years of age. On multivariate analysis, caustic ingestion (OR 11.3 CI 3.0 – 42.5), first degree family history of ESCC (OR 3.5 CI 1.3 – 9.5) and poor housing (OR 2.0 CI 1.1 – 3.5) were independent predictors.Conclusions: Majority hailed from the Central and Eastern provinces  probably due to proximity to the study centres. A large proportion of cases were young compared to studies in other high incidence regions in the world. Low socio-economic status, family history of ESCC and a history of caustic ingestion were significant risk factors.Key Words: Esophageal, Squamous Cell Carcinoma, Risk Factors, Keny

Assessment of pulmonary function in rheumatoid arthritis patients attending Rheumatology Clinics in Nairobi

Background: Pulmonary involvement is a frequent and among the most severe extra-articular manifestations of Rheumatoid Arthritis (RA) ranking as the second cause of mortality in this patient population. Rheumatoid arthritis can a ect the lung parenchyma, airways and pleura. Pulmonary complications are directly responsible for 10-20% of all mortality in RA patients. Spirometry is becoming increasingly available in Kenya and could be used in peripheral areas to screen and monitor for pulmonary function abnormalities in well characterized patient populations such as those with RA. Abnormalities detected by pulmonary function tests may precede symptoms by years and lead to early diagnosis of pulmonary fibrosis in rheumatoid arthritis and hence intervention. Objective: To determine the prevalence of pulmonary function abnormalities in rheumatoid arthritis patients attending Rheumatology Clinics in Nairobi. Design: Cross sectional descriptive study. Setting: Nairobi Rheumatology Clinics in Kenyatta National Hospital, Aga Khan University Hospital and Mater Hospital. Methods: Rheumatoid arthritis patients aged 13 to 65 years who fulfilled the study inclusion criteria were recruited. Sociodemographic characterictics and respiratory symptoms were assessed using Lung Tissue Research Consortium questionnaire (LTRC) and RA disease activity was established by Disease Activity Score (DAS28). Pulmonary function tests were then done using Spirolab 111 according to the American Thoracic Society recommendations. Results: One hundred and sixty six RA patients were recruited; the male to female ratio was 1:9.3, with a median age of 47 years. The overall six month prevalence of pulmonary function abnormalities was 38.5% as measured by Spirometry and all our patients did not carry any prior pulmonary disease diagnosis. The predominant ventilatory defect was obstructive pattern at 20.4%, followed by restrictive pattern at 16.8% and least common being a mixed picture at 1.2%. Factors that were shown to be independently associated with pulmonary function abnormalities were age and RA disease activity. Respiratory symptoms that were predictive of PFTs abnormalities were cough, increased frequency of chest colds and illnesses and phlegm. Conclusion: High prevalence of pulmonary function abnormalities was observed. Respiratory symptoms, older age and ongoing disease activity can identify patients in greatest need of further pulmonary evaluation. Key words : Rheumatoid Arthritis, Pulmonary function test, Nairobi Rheumatology Clinic

Arthrheuma Society of Kenya consensus report: Recommendations for the management of rheumatoid arthritis

Objectives: This study aims to recommend Arthrheuma Society of Kenya (ARSK) proposed Rheumatoid Arthritis (RA) management and to compose a national expert opinion management of RA under guidance of current guidelines and implantation and dissemination of these international guidelines into our clinical practice.Materials and methods: A scientific committee of nineteen experts consisting of nine rheumatologists, three rheumatology nurses and seven physicians was formed. The recommendations, systemic reviews, and meta-analysis including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft ARSK recommendations for management of RA opinion whose roof consisted of international treatment recommendations, particularly the assessment of American College of Rheumatology (ACR)/ European League Against Rheumatism was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation.Results: Panel comprised of six basic principles and recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength.Conclusion: ARSK expert opinion for the management of RA was developed based on scientifi c evidence. These recommendations will be updated regularly in accordance with current developments.Keywords: Arthrheuma Society of Kenya, Rheumatoid Arthritis, Management guideline