Oesophageal cancer and Kaposi’s Sarcoma in Malawi: a comparative analysis

Given that oesophageal cancer (OC) is common in Malawi and its outcome is so dismal, would it be pragmatic to promptly mitigate the effects of smoking, alcohol and aflatoxins rather than seek a higher degree of local evidencefor their role in OC? We retrospectively analysed a total of 13,217 OC andKaposi’s sarcoma (KS) cases as recorded in the Malawi National Cancer Registry from 1985 to February, 2006. We found no OC clustering to suggest a role for culturally variable habits like smoking, alcohol, maize use and maize storage in the country. It may be that drinking and eating hotfoods physically damages the oesophageal mucosa, this is in line with work recently reported from Asia. We also found that OC numbers have risen in line with KS (and HIV) suggesting a link between these conditions

The need for a national cancer policy in Malawi

Cancer is causing a lot of suffering and death in Africa but is not considered a major health problem in Africa. This needs to change. Cancer should be given equal emphasis to HIV/AIDS, tuberculosis (TB) and Malaria. A national cancer policy is required in Malawi to develop and improve evidence-based cancer prevention, early diagnosis, curative and palliative therapy. A national cancer policy is crucial to ensure a priotised, clear, coordinated and sustained fight against cancer. When no policy exists, events are likely to be random, stakeholders and practitioners in the fight against cancer may not agree on how to proceed, may duplicate efforts or may neglect areas that would have greater nationwide impact resulting in poor quality activities and haphazard development.Malawi Medical Journal Vol. 20 (4) 2008: pp. 124-12

Effect of organic and inorganic phosphorus sources on maize yields in an acid soil in western Kenya

Maize production in western Kenya is commonly limited by P deficiencies and aluminum phytotoxicity. Due to high costs of imported fertilizers and lime, focus is now shifting to solutions that utilize local resources. We tested the effect of three inorganic P sources i.e., triple superphosphate (TSP), Minjingu phosphate rock (MPR) and Busumbu phosphate rock (BPR), each applied in combination with two organic materials (OMs) i.e., farmyard manure (FYM) and Tithonia diversifolia green manure (tithonia), or with urea on soil chemical properties related to soil acidity, P availability and maize yields for three consecutive seasons in western Kenya. The OMs and inorganic P sources were applied to provide 20 and 40 kg P ha-1 respectively in their combination. Where urea was used, the inorganic P sources were applied at 60 kg P ha-1. Maize did not respond to application of TSP, MPR or BPR with urea in the first two seasons. However, after three seasons, maize significantly responded to application of MPR with urea. FYM was more effective than tithonia in increasing the labile inorganic P pools but it gave lower maize yields than tithonia which was more effective in reducing the exchangeable Al. It appears that the ability of an OM to lower the exchangeable Al is more important inincreasing maize yields than its ability to increase P availability. The effectiveness of the inorganic P sources in increasing maize yields followed the order of their effectiveness in increasing available P, i.e., TSP[MPR [BPR, once Al phytotoxicity was reduced by application of tithonia but the difference between TSP and MPR was not significant. The extra maize yield obtained by the additional 40 kg P ha-1 from the inorganic P sources was, however, in most cases not substantial enough to justify their use. Economic considerations may therefore favour the use of tithonia or FYM when applied alone at 20 kg P ha-1 than when combined with any of the inorganic P sources used in this study at a total P rate of 60 kg ha-1

Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism

Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.Conclusion: Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making

Phosphorus Sorption and Lime Requirements of Maize Growing Acid Soils of Kenya

In Kenya, maize (Zea mays L.) is mainly grown on acid soils in high rainfall areas. These soils are known for low available phosphorus (P), partly due to its sorption by aluminium (Al) and iron oxides. The study determined soil P sorption, lime requirements and the effects of lime on soil pH, Al levels and available P on the main maize growing acids soils in the highlands east and west of Rift Valley (RV), Kenya. Burnt lime containing 21% calcium oxide was used. The soils were strongly to extremely acid (pH 4.85-4.07), had high exchangeable Al3+ (> 2 cmol Al kg-1) and Al saturation (> 20% Al), which most maize germplasm grown in Kenya are sensitive to. The base cations, cation exchange capacity and available P (< 10 mg P kg-1 bicarbonate extractable P) were low, except at one site in the highlands east of RV indicative with history of high fertilizer applications. Highlands east of RV soils had higher P sorption (343-402 mg P kg-1) than the west (107-258 mg P kg-1), probably because of their high Al3+ ions and also the energies of bonding between the soil colloids and phosphate ions. Highlands east of RV also had higher lime requirements (11.4-21.9 tons lime ha-1) than the west (5.3-9.8 tons lime ha-1). Due to differences in soil acidity, Al levels and P sorption capacities within and between highlands east and west of RV, blanket P fertilizer and lime recommendations may not serve all soils equally well. Keywords: acid soils, phosphorus sorption, lime requirement

Effects of lime, phosphorus and rhizobia on Sesbania sesban performance in a Western Kenyan acid soil

Aluminium (Al) toxicity, phosphorus (P) deficiency and low rhizobia populations limit Sesbania (Sesbania sesban) performance in tropical acid soils. The study determined the i) indigenous rhizobia populations that nodulate sesbania and ii) effects of lime (0 and 4 t/ha), P-fertilizer (0 and 60 kg/ha) and acid tolerant rhizobia (0 and inoculation) on soil and selected sesbania accessions performance in Western Kenya acid soil. Study site had acid soil, low available P, nitrogen (N) and rhizobia populations that nodulate Sesbania (146 cells/g soil). Lime increased soil pH, while both lime and P-fertilizer increased available P. Aluminium toxicity tolerant and P-efficient accessions (SSBSA004, SSUG3, SSUG4 and SSUG5) had faster growth, higher nodulation, shoot P, and shoot N and response to treatments than the sensitive one (SSBSA203). After 7 months of growth, SSUG3 had highest shoot length (306 cm) and dry matter (5.64 tons/ha), hence, most suitable for building poles and fuel wood. SSUG5 accumulated the highest shoot N (222 kg N/ha) and was therefore, most suitable soil N replenishment. Thus, in acid P deficient and low rhizobial population soils of Western Kenya, the use of lime, P-fertilizer, rhizobia inoculation and Al toxicity tolerant Sesbania are important for Sesbania establishment and growth. Key words: Rhizobia, Sesbania, soil acidity, aluminum toxicity, lime, phosphorus