Patterns of Upper Gastrointestinal Diseases Based on Endoscopy in the Period 1998-2001

Upper gastrointestinal complaints are common in Kenya. Though these have remained unchanged over the last 20 years, the pattern of upper gastrointestinal disease on endoscopic examination seems to be changing. There appears to be progressive increase in oesophagitis and cancer of the stomach. Peptic ulcer disease has remained stable while Cancer of the oesophagus is still common. The paper intends to report on endoscopic findings at the Centre for Clinical Research, Kenya Medical Research Institute (KEMRI) over the period October 1998 and May 2001. The sources of information are records made at the time of endoscopy and histology reports on biopsies taken. Seven hundred and sixty eight patients were endoscoped. The male to female ratio was 1.7:1 with mean age \ub1SD of 40.8 \ub120.1 years and age range was 3 to 96 years. Majority of the patients had abnormal findings with gastritis being the most common ( 25.8%). It is concluded that gastritis is an important cause of morbidity in Kenya. Oesophagitis, mainly due to gastroesopahageal reflux disease, seems to be on the increase. Gastric cancer is not as rare as previously thought and peptic ulcer disease is still common

Developing Clinical Strength-of-Evidence Approach to Define HIV-Associated Malignancies for Cancer Registration in Kenya

Background Sub-Saharan Africa cancer registries are beset by an increasing cancer burden further exacerbated by the AIDS epidemic where there are limited capabilities for cancer-AIDS match co-registration. We undertook a pilot study based on a “strength-of-evidence” approach using clinical data that is abstracted at the time of cancer registration for purposes of linking cancer diagnosis to AIDS diagnosis. Methods/Findings The standard Nairobi Cancer Registry form was modified for registrars to abstract the following clinical data from medical records regarding HIV infection/AIDS in a hierarchal approach at time of cancer registration from highest-to-lowest strength-of-evidence: 1) documentation of positive HIV serology; 2) antiretroviral drug prescription; 3) CD4+ lymphocyte count; and 4) WHO HIV clinical stage or immune suppression syndrome (ISS), which is Kenyan terminology for AIDS. Between August 1 and October 31, 2011 a total of 1,200 cancer cases were registered. Of these, 171 cases (14.3%) met clinical strength-of-evidence criteria for association with HIV infection/AIDS; 69% (118 cases were tumor types with known HIV association – Kaposi’s sarcoma, cervical cancer, non-Hodgkin’s and Hodgkin’s lymphoma, and conjunctiva carcinoma) and 31% (53) were consistent with non-AIDS defining cancers. Verifiable positive HIV serology was identified in 47 (27%) cases for an absolute seroprevalence rate of 4% among the cancer registered cases with an upper boundary of 14% among those meeting at least one of strength-of-evidence criteria. Conclusions/Significance This pilot demonstration of a hierarchal, clinical strength-of-evidence approach for cancer-AIDS registration in Kenya establishes feasibility, is readily adaptable, pragmatic, and does not require additional resources for critically under staffed cancer registries. Cancer is an emerging public health challenge, and African nations need to develop well designed population-based studies in order to better define the impact and spectrum of malignant disease in the backdrop of HIV infection

Sodium Stibogluconate (SSG) & Paromomycin Combination Compared to SSG for Visceral Leishmaniasis in East Africa: A Randomised Controlled Trial

Visceral leishmaniasis (VL) is a parasitic disease with about 500,000 new cases each year and is fatal if untreated. The current standard therapy involves long courses, has toxicity and there is evidence of increasing resistance. New and better treatment options are urgently needed. Recently, the antibiotic paromomycin (PM) was tested and registered in India to treat this disease, but the same dose of PM monotherapy evaluated and registered in India was not efficacious in Sudan. This article reports the results of a clinical trial to test the effectiveness of injectable PM either alone (in a higher dose) or in combination with sodium stibogluconate (SSG) against the standard SSG monotherapy treatment in four East African countries—Sudan, Kenya, Ethiopia and Uganda. The study showed that the combination of SSG &PM was as efficacious and safe as the standard SSG treatment, with the advantages of being cheaper and requiring only 17 days rather than 30 days of treatment. In March 2010, a WHO Expert Committee recommended the use of the SSG & PM combination as a first line treatment for VL in East Africa

Geographical Variation in the Response of Visceral Leishmaniasis to Paromomycin in East Africa: A Multicentre, Open-Label, Randomized Trial

Visceral leishmaniasis (VL) is a fatal parasitic disease with 500,000 new cases each year according to WHO estimates. New and better treatment options are urgently needed in disease endemic areas due to the long courses, toxicity and development of resistance to current treatments. Recently, the antibiotic paromomycin was tested and registered in India to treat this disease. The current study describes a clinical trial to test the effectiveness of injectable paromomycin, either alone or in combination with the standard drug sodium stibogluconate in three East African countries—Sudan, Kenya and Ethiopia. The study showed that at the same paromomycin dose that was successfully used and registered in India, a far poorer outcome was obtained, particularly in Sudan, suggesting that there are either differences in the patients ability to respond to the drug or in the susceptibility of parasites in East Africa compared with those in India. However, no major safety concerns were noted with the treatment. Further research was initiated to see if a higher dose of paromomycin would perform better, especially in Sudan. The results of this and the performance of the combination arm will be reported later. Our study highlights the importance of considering geographical differences to treatment responses

Patterns of upper gastrointestinal diseases based on endoscopy in the period 1998-2001

Upper gastrointestinal complaints are common in Kenya. Though these have remained unchanged over the last 20 years, the pattern of upper gastrointestinal disease on endoscopic examination seems to be changing. There appears to be progressive increase in oesophagitis and cancer of the stomach. Peptic ulcer disease has remained stable while Cancer of the oesophagus is still common. The paper intends to report on endoscopic findings at the Centre for Clinical Research, Kenya Medical Research Institute (KEMRI) over the period October 1998 and May 2001. The sources of information are records made at the time of endoscopy and histology reports on biopsies taken. Seven hundred and sixty eight patients were endoscoped. The male to female ratio was 1.7:1 with mean age ±SD of 40.8 ±20.1 years and age range was 3 to 96 years. Majority of the patients had abnormal findings with gastritis being the most common (25.8%). It is concluded that gastritis is an important cause of morbidity in Kenya. Oesophagitis, mainly due to gastroesopahageal reflux disease, seems to be on the increase. Gastric cancer is not as rare as previously thought and peptic ulcer disease is still common.African Journal of Health Sciences Vol. 12(1-2) 2005: 49-5

Comparison of demographics and percentage with known HIV-associated cancer cases between those with HIV(+) serology and those who met clinical criteria only.

<p>[<u>Notes</u>: *Statistically significant difference (p = 0.005) between positive serology group (n = 47) and clinical criteria only group (n = 124) with respect to the patient characteristic (Chi-square test)].</p

Level of strength-of-evidence of HIV infection/AIDS in 171 cancer cases that were registered.

<p>Of the subsequent confirmed HIV(+) serology 12 were identified at the Comprehensive Care Clinic and 10 at the Department of Radiation Oncology at Kenyatta National Hospital. [<u>Notes</u>: *Statistically significant difference (p = 0.022) between positive serology group (n = 47) and clinical criteria only group (n = 124) with respect to the level strength-of-evidence (Chi-square test)].</p

Tumor types of 171 cancer cases with hierarchal association of HIV infection/AIDS.

<p>Of these total cases, 118 (69%) had demonstrable HIV association (i.e., KS, cervix, NHL, conjunctiva and Hodgkin’s disease) and the remaining 53 would be considered non-AIDS-defining cancer. [<u>Notes</u>: <b><i>Bold italics</i></b> – known HIV-associated malignancy; NOS – not otherwise specified].</p

Nairobi Cancer Registry (NCR) – reporting entities comprising this cancer population-based registry utilized for this study number of cases that met strength-of-evidence criteria for cancer-AIDS (HIV infection) match.

<p>Nairobi Cancer Registry (NCR) – reporting entities comprising this cancer population-based registry utilized for this study number of cases that met strength-of-evidence criteria for cancer-AIDS (HIV infection) match.</p

CONSORT Patient Flowchart – SSG <i>vs.</i> PM.

<p>SSG, sodium stibogluconate; PM, paromomycin sulphate; SAE, serious adverse event; LTFU, loss to follow-up; ITT, intention-to-treat; PP, per protocol. Patients included in the SSG (20 mg/kg/day for 30 days) vs. PM (20 mg/kg/day for 21 days) arms; <b>^a</b> data from these patients were previously reported <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001674#pntd.0001674-Musa1" target="_blank">[14]</a>.</p