Tuberculous anal fistulas-prevalence and clinical features in an endemic area

Introduction: The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulas. Patients and methods: This was a prospective study of all patients who underwent surgery for anal fistulas at the Colorectal Surgery Unit at Groote Schuur Hospital, Cape Town, from 2004 to 2006. Tissue was submitted for histopathological examination, Ziehl-Neelsen (ZN) staining and TB culture. The patients with proven TB were followed up until January 2008. Results: During the 3-year study period, 117 operations were performed on 96 patients. TB was diagnosed in 7 of the 96 patients (7.3%). In 5 of these 7 cases, the diagnosis of TB could be proven on histological examination and ZN staining, while in 2 cases the diagnosis could only be made on TB culture. None of the 7 patients had systemic features suggestive of TB, and only 1 had evidence of TB on a chest radiograph. Five patients were HIV-negative, and 2 declined testing. After a median follow-up of 2 years, 5 of 7 patients had evidence of recurrent or persistent fistulas, despite having completed 6 months of TB treatment. Conclusion: At a referral hospital in an endemic area, TB was present in 7.3% of anal fistulas. Histopathological examination including ZN staining was inadequate to make the diagnosis in a third of these patients. Tissue from anal fistulas should therefore routinely be sent for TB culture as well as histopathological examination and ZN staining in areas where TB is prevalent

Analysis of the scientific aspects related to minibus taxi collisions

Paper presented at the 26th Annual Southern African Transport Conference 9 - 12 July 2007 "The challenges of implementing policy?", CSIR International Convention Centre, Pretoria, South Africa. ABSTRACT: A study recently done by the Automobile Association of South Africa recorded an annual total of 70 000 minibus taxi crashes which indicates that taxis in SA amount for double the rate of crashes than all other passenger vehicles. Detailed accident data is not available for this category of vehicle, so there is insufficient evidence to support a clear cause for the number of fatalities in minibus taxi accidents. Any crash results from a combination of circumstances converging to a point where the driver does not have the skills or the options to avoid the crash. Systematic investigation is necessary to identify patterns of failure resulting in a crash. This could be associated with driver behaviour, road conditions or/and vehicle features. This paper is a follow up of the paper presented at SATC 2006 and will examine police records and case studies of minibus taxi accidents to scientifically identify any trends and factors causing these accidents. Crucial new evidence has emerged during this investigation.This paper was transferred from the original CD ROM created for this conference. The material on the CD ROM was published using Adobe Acrobat technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: [email protected] URL: http://www.doctech.co.z

Towards a safer minibus taxi industry in South Africa

Paper presented at the 25th Annual Southern African Transport Conference 10 - 13 July 2006 "2010: Will transport infrastructure and systems be ready?", CSIR International Convention Centre, Pretoria, South Africa.This paper was transferred from the original CD ROM created for this conference. The material on the CD ROM was published using Adobe Acrobat technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: [email protected] URL: http://www.doctech.co.z

Abstract A12: Ethnic differences in the clinical and pathological characteristics of breast cancer among Kenyan women

Abstract: Background: Breast cancer is the most common female malignancy worldwide. The effect of race and ethnicity on breast cancer has been the subject of much investigation. However, there are no published data from specific regions of sub-Saharan Africa with regards to the ethnic distribution of breast cancer and its subtypes. Objective: To investigate the differences in clinical and pathological characteristics of breast cancer in three major ethno-cultural groupings (Bantus, Nilotes and Cushites) in Kenya. Methods: A nationwide prospective study involving 15 public, faith-based and private institutions, which recruited patients with pathologically confirmed breast cancer between March 2012 and May 2015, was conducted. Relevant socio-demographic, clinical, reproductive and known breast cancer risk factor data were collected using a standardized questionnaire. Central pathology review and immunohistochemistry of all breast cancer tissue were done at Aga Khan University Hospital Nairobi. Proportions, chi-square tests, and logistic regression were used in the analysis of data. Results: Among the 867 female study participants with malignant breast tumor, 675 (77.8%) were Bantus, 148 (17.0%) were Nilotes, 20 (2.4%) were Cushites, and 24 (2.8%) were patients of mixed ethnicity. Bantus were more likely than the other three ethnic groups to fall within the 40-49 year age group (32 vs 19, 15, and 25% respectively, p=0.002), more likely to have at most secondary education (27.6 vs 17.6, 0, and 16.7%, p=0.0003), and more likely to be farmers (33.9 vs 19.6, 0.0, and 16.7%, p Conclusion: The differences observed for some of the clinical and pathologic features of Breast Cancer among the three distinct ethnic groups in Kenya could be multifactorial and attributable to socio economic indicators, lifestyle factors and probable genetic variations. The association of specific measurements and biomarkers of obesity from Breast cancer patients among the ethnic Kenyan population and the association of serum estradiol concentrations with ethnicity and breast cancer subtypes are areas of future research. Further research to explore the BC incidence among the ethnic groups may provide insight into yet unexplored risk factors and etiology of breast cancer

Investigation on the hereditary basis of colorectal cancers in an African population with frequent early onset cases

CITATION: Katsidzira, L. et al. 2019. Investigation on the hereditary basis of colorectal cancers in an African population with frequent early onset cases. PLoS ONE, 14(10). doi:10.1371/journal.pone.0224023The original publication is available at https://journals.plos.org/plosone/Background: Approximately 25% of colorectal cancer patients in sub-Saharan Africa are younger than 40 years, and hereditary factors may contribute. We investigated the frequency and patterns of inherited colorectal cancer among black Zimbabweans. Methods: A population-based cross-sectional study of ninety individuals with a new diagnosis of colorectal cancer was carried out in Harare, Zimbabwe between November 2012 and December 2015. Phenotypic data was obtained using interviewer administered questionnaires, and reviewing clinical and pathology data. Cases were screened for mismatch repair deficiency by immunohistochemistry and/or microsatellite instability testing, and for MLH1, MSH2 and EPCAM deletions using multiplex ligation-dependent probe amplification. Next generation sequencing using a 16-gene panel was performed for cases with phenotypic features consistent with familial colorectal cancer. Variants were assessed for pathogenicity using the mean allele frequency, phenotypic features and searching online databases. Results: Three Lynch syndrome cases were identified: MSH2 c.2634G>A pathogenic mutation, c.(1896+1_1897–1)_(*193_?)del , and one fulfilling the Amsterdam criteria, with MLH1 and PMS2 deficiency, but no identifiable pathogenic mutation. Two other cases had a strong family history of cancers, but the exact syndrome was not identified. The prevalence of Lynch syndrome was 3·3% (95% CI 0·7–9·4), and that of familial colorectal cancer was 5·6% (95% CI, 1·8–12·5). Conclusions: Identifying cases of inherited colorectal cancer in sub-Saharan Africa is feasible, and our findings can inform screening guidelines appropriate to this setting.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224023Publisher's versio

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London