Prospective endoscopic study of duodenal ulcer in Zimbabwean Blacks

A clinical endoscopic study of duodenal ulcer problems in black Zimbabweans.One thousand seven hundred and fourteen Black Zimbabwean patients underwent upper gastrointestinal endoscopy. Demographic details of the patients were analyzed. A randomly chosen cohort of 50 patients with duodenal ulceration was compared to age and sex matched controls regarding lifestyle mid H. pylori infection. Five hundred and sixteen patients had active duodenal ulcers, giving a crude prevalence rate of ulceration of 456 per 100 000 new hospital cases. There is a difference from the disease in Western countries in several respects. The incidence appears to be increasing in Zimbabwe. There was no significant difference between ulcer patients and controls in their association with alcohol consumption, cigarette smoking, urban residence and salicylate ingestion

Multicentre study of the treatment of primary liver cancer in Africa with two anthracycline drugs

A study of the treatment of primary liver cancer in tropical Africa.Hepatocellular carcinoma (HCC) is among the twelve commonest cancers affecting mankind. In tropical Africa HCC is the most common malignant tumor, particularly among men. In Kyadondo County of Uganda the incidence rate is 5,1 cases per 100 000 men. In Nigeria the figure quoted for both sexes is 5,9 per 100 000 population. In Zimbabwe the incidence among the Black population is 20,8 per 100 000, while in Mozambique the figure is 103,8 per 100 000 males. These figures are in contradiction to what is observed in Europe and North America. In England HCC occurs in 2,5 per 100 000, while in North America it is seen in 1,8 per 100 000

Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi

Objective To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa. Materials and methods A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed. Results In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%. Conclusions Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients

Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study [version 1; peer review: awaiting peer review]

BACKGROUND: Cryptococcal meningitis (CM) is the commonest neurological complication in patients with advanced HIV. Visual disturbance is a frequent presenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described. METHODS: We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology attributable to CM. 70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM. RESULTS: 79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p <0.001). In the CM group, retinal whitening was the commonest abnormality (50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/µl vs. 76 cells/µl; p = 0.79) or CSF opening pressure (21cm H20 vs. 27cm H20; p = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6). CONCLUSIONS: Whether the presence of CM retinopathy could be used as a marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy to be utilised in future CM studies. TRIAL REGISTRATION: ISRCTN (ISRCTN45035509) 19/06/2012

HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis.

BACKGROUND: The frequency of ocular surface squamous neoplasias (OSSNs) has been increasing in populations with a high prevalence of infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and infection with human papillomavirus (HPV). We aimed to quantify the association between HIV/AIDS and HPV infection and OSSN, through systematic review and meta-analysis. METHODS: The articles providing data on the association between HIV/AIDS and/or HPV infection and OSSN were identified in MEDLINE, SCOPUS and EMBASE searched up to May 2013, and through backward citation tracking. The DerSimonian and Laird method was used to compute summary relative risk (RR) estimates and 95% confidence intervals (95% CI). Heterogeneity was quantified with the I(2) statistic. RESULTS: HIV/AIDS was strongly associated with an increased risk of OSSN (summary RR=8.06, 95% CI: 5.29-12.30, I(2)=56.0%, 12 studies). The summary RR estimate for the infection with mucosal HPV subtypes was 3.13 (95% CI: 1.72-5.71, I(2)=45.6%, 16 studies). Four studies addressed the association between both cutaneous and mucosal HPV subtypes and OSSN; the summary RR estimates were 3.52 (95% CI: 1.23-10.08, I(2)=21.8%) and 1.08 (95% CI: 0.57-2.05, I(2)=0.0%), respectively. CONCLUSION: Human immunodeficiency virus infection increases the risk of OSSN by nearly eight-fold. Regarding HPV infection, only the cutaneous subtypes seem to be a risk factor

Management of Clostridium Difficile: Case study and review of the basic tenets

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The aetiology and associations of conjunctival intraepithelial neoplasia

AIM: To summarise the main causes and associations of conjunctival intraepithelial neoplasia (CIN) found in the literature to date. METHOD: Literature search using Ovid databases on the NHS Scotland E‐library, Medline, and the Cochrane Library. The internet search engine Google Scholar was also used to identify relevant articles. RESULTS: The main causes and associations of CIN in the literature are sun exposure and distance from the equator; human papillomavirus infection, increased p53 expression, and HIV seropositivity. It has been found that in HIV positive individuals CIN is on the increase with people being affected with more aggressive tumours at younger ages. CONCLUSION: Given that CIN is becoming more common in HIV infected populations and that it has the potential to cause severe disability, it is important to improve our understanding of the condition. Early identification of CIN by an understanding of its aetiology and associations may enable the implementation of preventative measures to reduce its incidence and potentially lead to the diagnosis and further management of conditions such as HIV. Young people presenting with CIN in particular may benefit from HIV testing