Breast Cancer in an Ethiopian Population, Addis Ababa

Background: Breast cancer is a major life-threatening public health problem of great concern. Long-term increases in the incidence of the disease are being observed in both industrialized and developing world.Methods: During 1995-99, 137 biopsy proven breast cancer cases underwent surgical treatment at Tikur Anbessa Hospital, Addis Ababa. Of these cases, records of 125 were retrieved and analyzed to assess the pattern and treatment outcome of the disease.Results: The median age of females was 40 years. The median duration of the presenting symptom on admission was nearly 1 year. Clinically, majority of cases had stage III disease. Invasive ductal carcinoma was the most frequent type. Eighty-nine (71.2%) patients underwent modified radical mastectomy. During a short follow-up, 50 (45.9%) of 109 patients were seen with recurrences. Only 4 cases were seen at 5 or more years.Conclusion: In our series, breast cancer affected mainly young women; patients presented excessively late a probable contributor to the high rate of early relapse. Follow-up was poor. Public education on the importance of regular self breast examination to detect breast cancer should be emphasized

The Design of Printed Hybrid Constructs to Serve as Cartilage Templates for Bone Repair

With an estimated annual incidence of over 2.2 million cases across the world, critical size bone defects pose an unmet challenge requiring improved therapeutic strategies. Current clinical solutions, namely autologous and allogeneic grafts, are associated with a number of complications which include supply shortage, donor site morbidity and immune rejection. Given the poor vascularization observed with bioresorbable bone template scaffolds, some have turned to engineering the endogenous repair pathway by developing implantable cartilage templates susceptible to the bone transformation process known as endochondral ossification seen in native defects. Yet considerations relating to the implants' mechanical behavior, porosity and swelling, all of which are crucial to mimicking the endochondral ossification process, remain largely unaddressed in past studies. Through a parameter-driven preliminary study, we have devised a method to improve spatial resolution and property modulation by incorporating additive manufacturing into the fabrication process of cartilage templates destined for ossification-mediated defect repair. Based on our findings that hydrogel extrusion introduces structural discontinuities leading to excessive swelling and time-dependent mechanical deformation, we advance a biofabrication method involving (1) the 3D printing of a porous hybrid construct comprised of a stiff polycaprolactone network interwoven with sacrificial poly(ethylene glycol) material, (2) the casting of a cell-laden hydrogel material into the primary porous network, and (3) the evacuation of the sacrificial poly(ethylene glycol) material to create a secondary porous network. The architecture of the generated templates was modulated by varying the widths of the secondary pores and hydrogel struts. Generated templates were subjected to geometric analysis by photography, porosity evaluation by micro-computed tomography, stress relaxation testing and a swelling study. The incorporation of a stiff network constrained swelling by more than half, while decreased porosity-to-hydrogel content ratios mitigated time-dependent deformation.M.S., Biomedical Engineering -- Drexel University, 201

The effects of dual micronutrient supplementation on thyroid function in school children: An experimental study

Background: The presence of iron and or vitamin A deficiency in children limits the effectiveness of the iodine intervention program in areas where iodine deficiency is endemic. This study was aimed at assessing the role of dual micronutrient supplementation on thyroid function in severe iodine deficient school children age 6-16 years in Ethiopia.Methods: From 2006 to 2007 an experimental study was conducted on 397 children, all with visible goiter grade of which 6.1% and 10.3% vitamin A and iron deficient respectively. A week after baseline data collection and de-worming, all children with visible goitre (n=332) but without iron and vitamin A deficiency were randomly grouped into four, A to D groups. Vitamin A deficient children (n=24) were randomly allocated to group A and group B while anaemic children (n=41) were distributed into group C and group D. Group A received 400mg oral iodized oil and group B received 200,000IU vitamin A plus 400mg oral iodized oil. Group C received 400mg oral iodized oil while group D received 100mg iron sulphate with folic acid and 400 mg oral iodized oil. Iron supplementation was continued two doses per day for six weeks. Vitamin A supplemented group received additional dose at six month. Post intervention data on iodine, vitamin A and iron status were collected at 6 and 11 month.Results: Children supplemented with iron + oral iodized oil capsule had significant goitre reduction than oral iodized oil supplemented group. The mean concentrations of thyroid hormone (T4) and Urinary iodine excretion (UIE) in iron + iodine supplemented group were significantly higher than the iodine alone supplemented group at 6 months after the intervention. Hemoglobin level at baseline in all study subjects and at 11 month after intervention in group D (iron + iodine supplemented group) significantly (P<0.05) correlated with T4 level. The significant goitre reduction in iron + iodine supplemented group than iodine alone supplemented group and significant correlation between level hemoglobin and T4 at baseline and at 11 month after intervention probably indicate that iron and iodine have a functional interaction in thyroid iodine metabolism.Conclusion: Supplementation of iodized oil with Iron is more effective in goitre reduction than iodine alone and this should be taken into consideration by iodine deficiency disorders (IDD) intervention programs

A micromirror array with annular partitioning for high-speed random-access axial focusing

Dynamic axial focusing functionality has recently experienced widespread incorporation in microscopy, augmented/virtual reality (AR/VR), adaptive optics, and material processing. However, the limitations of existing varifocal tools continue to beset the performance capabilities and operating overhead of the optical systems that mobilize such functionality. The varifocal tools that are the least burdensome to drive (ex: liquid crystal, elastomeric or optofluidic lenses) suffer from low (~ 100 Hz) refresh rates. Conversely, the fastest devices sacrifice either critical capabilities such as their dwelling capacity (ex: acoustic gradient lenses or monolithic micromechanical mirrors) or low operating overhead (e.g., deformable mirrors). Here, we present a general-purpose random-access axial focusing device that bridges these previously conflicting features of high speed, dwelling capacity and lightweight drive by employing low-rigidity micromirrors that exploit the robustness of defocusing phase profiles. Geometrically, the device consists of an 8.2 mm diameter array of piston-motion and 48 um-pitch micromirror pixels that provide 2pi phase shifting for wavelengths shorter than 1 100 nm with 10-90 % settling in 64.8 us (i.e., 15.44 kHz refresh rate). The pixels are electrically partitioned into 32 rings for a driving scheme that enables phase-wrapped operation with circular symmetry and requires less than 30 V per channel. Optical experiments demonstrated the array's wide focusing range with a measured ability to target 29 distinct, resolvable depth planes. Overall, the features of the proposed array offer the potential for compact, straightforward methods of tackling bottlenecked applications including high-throughput single-cell targeting in neurobiology and the delivery of dense 3D visual information in AR/VR.Comment: 38 pages, 8 figure

Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis

Background The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region. Methods We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database. Findings 83 studies were included, which consisted of 26 788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74·7%, range 30·3–100%, I2=93·3%, p<0·0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] −18·1%, 95% CI −28·2 to −8·0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13·2%, 5·7 to 20·7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (–10·5%, −19·3 to −1·6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously. Interpretation Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa

Preliminary Results on Polypropylene Mesh Use for Abdominal Incisional Hernia Repairs: The Experience at KCMC - Moshi, Tanzania; 2001 -2005.

Background: Incisional hernia is a major surgical problem. Several methods of hernia repair have been described but their outcome has been disappointing. This preliminary retrospective study reports on our experience with polypropylene mesh repair. Methods: The technique of mesh placement on anterior rectus abdominis fascia also termed subcutaneous or fascial on lay placement was done on 31 patients from January 2001 to October 2005. Patients'case notes were retrieved and used to assess for patient related risk factors and hernia related risk factors for its development and recurrence. Post operative complications and duration of postoperative hospitalization were recorded. Results: Obesity (52%) and history previous history of gynaecological procedures (68%) formed the major associated factors of incisional hernias. Seroma (25%), wound infection (10%) and haematoma (3%) were the commonest postoperative complications. One patient with deep wound infection had the mesh removed. The duration of hospital stay ranged from 2 to 27 days with a mean of 6days. The median follow up period was 16 days and ranged from 2 weeks to 46 months. No case of hernia recurrence was reported during the follow-up period. Conclusion: The number of case studied and follow-up period were inadequate to make a definitive conclusion. There is therefore a need to undertake a prospective study comparing the conventional use of suturing technique for repair of abdominal incisional hernias versus polypropylene method of repair using the fascial on lay technique in the African situation

Breast Cancer in an Ethiopian Population, Addis Ababa

Background: Breast cancer is a major life-threatening public health problem of great concern. Long-term increases in the incidence of the disease are being observed in both industrialized and developing world. Methods: During 1995-99, 137 biopsy proven breast cancer cases underwent surgical treatment at Tikur Anbessa Hospital, Addis Ababa. Of these cases, records of 125 were retrieved and analyzed to assess the pattern and treatment outcome of the disease. Results: The median age of females was 40 years. The median duration of the presenting symptom on admission was nearly 1 year. Clinically, majority of cases had stage III disease. Invasive ductal carcinoma was the most frequent type. Eighty-nine (71.2%) patients underwent modified radical mastectomy. During a short follow-up, 50 (45.9%) of 109 patients were seen with recurrences. Only 4 cases were seen at 5 or more years. Conclusion: In our series, breast cancer affected mainly young women; patients presented excessively late a probable contributor to the high rate of early relapse. Follow-up was poor. Public education on the importance of regular self breast examination to detect breast cancer should be emphasized