Causes of cervical lymphadenopathy at Kamuzu Central Hospital

AimDescription of pathologic causes of cervical lymphadenopathy at Kamuzu Central Hospital.IntroductionThe evaluation of cervical lymphadenopathy is a common diagnostic challenge facing clinicians. Previously at Kamuzu Central Hospital (KCH) tuberculosis (TB) was reported to be the most common cause of cervical lymphadenopathy However, no recent study has assessed this common diagnostic challenge in Malawi, particularly since the beginning of the HIV epidemic and the subsequent scale-up of antiretroviral therapy.MethodsWe conducted a cross-sectional study of all cervical lymph node specimens from the KCH pathology laboratory between 1 July 2011 and 28 February 2013 and describe patient age, gender, and pathologic diagnoses.ResultsOur search of the KCH pathology database yielded 179 cases. Of these, 143 (77%) were histologic specimens (open biopsy or core needle samples) while 34 (23%) were cytology specimens. The age range was from 0 to 76 years with a mean of 30 (SD: 19). In adults, the most common diagnosis was malignancy (n=41, 35%), while in children 15 cases each of malignancy and benign masses were diagnosed. Only 6 cases (5%) of TB were diagnosed in adults, and 4 cases (6%) of TB were diagnosed in children.ConclusionOur study shows more malignancy and much less TB than a prior study of cervical lymphadenopathy at KCH. With the successful initiaion of the KCH Pathology Laboratory in 2011, we recommend biopsy or FNA early in the workup of cervical lymphadenopathy to prevent long delays in diagnosis and treatment of curable cancers

Human papillomavirus in head and neck squamous cell carcinoma: A descriptive study of histologically confirmed cases at Kamuzu Central Hospital in Lilongwe, Malawi

Background: Head and neck squamous cell carcinoma (HNSCC) is common in sub-Saharan Africa, but the aetiologic contribution of human papillomavirus (HPV) is not well established.Methods: We assessed HNSCC cases for HPV using p16 immunohistochemistry (IHC) in Malawi. Associations between p16 IHC and tumour site, behavioural risk factors, demographic characteristics, and HIV status were examined.Results: From 2010 to 2014, 77 HNSCC cases were identified. Mean age was 52 years, 50 cases (65%) were male, and 48 (62%) were in the oropharynx (OP) or oral cavity (OC). HIV status was known for 35 patients (45%), with 5 (14%) HIV-infected. Substance use was known for 40 patients (52%), with 38% reporting any tobacco and 31% any alcohol. Forty-two cases (55%) had adequate tissue for p16 IHC, of which seven (17%) were positive, including 22% of OP/OC tumours.Conclusions: Despite high cervical cancer burden, HPV-associated HNSCC is not very common in Malaw

Risk factors for common cancers among patients at Kamuzu Central Hospital in Lilongwe, Malawi: A retrospective cohort study

Background: Little is known about risk factors for different cancers in Malawi. This study aimed to assess risk factors for and epidemiologic patterns of common cancers among patients treated at Kamuzu Central Hospital (KCH) in Lilongwe, and to determine the prevalence of Human Immunodeficiency Virus (HIV) infection in the same population.Methods: We analysed data from the hospital-based KCH cancer registry, from June 2009 to September 2012, including data from a nested substudy on coinfections among cancer patients. Demographics and behavioural variables, including smoking and alcohol use, were collected through personal interviews with patients. We assessed HIV prevalence across cancer types. The distribution of cancer types was reported overall and by gender. Logistic regression was used to assess risk factors associated with common cancer types.Results: Data from 504 registered cancer patients were included—300 (59.5%) were female and 204 (40.5%) were male. Mean age was 49 years (standard deviation, SD = 16). There were 343 HIV-negative patients (71.2%), and 139 (28.8%) were HIV-positive. The commonest cancers were oesophageal (n = 172; 34.5%), cervical (n = 109; 21.9%), and Kaposi’s sarcoma (KS) (n = 52; 10.4%). Only 18% of cancer cases were histologically confirmed. Patients with oesophageal cancer were likely to be older than 50 years (odds ratio, OR = 2.22), male (OR = 1.47), and smokers (OR = 2.02). Kaposi’s sarcoma patients had the highest odds (OR = 54.4) of being HIV-positive and were also more likely to be male (OR = 6.02) and smokers. Cervical cancer patients were more likely to be HIV-positive (OR = 2.2) and less than 50 years of age.Conclusions: Age, smoking, and HIV are important risk factors for the 3 commonest cancer types (oesophageal, KS, and cervical) at this teaching hospital in Malawi. HIV is the single most important risk factor for Kaposi’s sarcoma and cervical cancer

Risk factors for common cancers among patients at Kamuzu Central Hospital in Lilongwe, Malawi: A retrospective cohort study

Little is known about risk factors for different cancers in Malawi. This study aimed to assess risk factors for and epidemiologic patterns of common cancers among patients treated at Kamuzu Central Hospital (KCH) in Lilongwe, and to determine the prevalence of Human Immunodeficiency Virus (HIV) infection in the same population

Causes of cervical lymphadenopathy at Kamuzu Central Hospital

Aim: Description of pathologic causes of cervical lymphadenopathy at Kamuzu Central Hospital. Introduction: The evaluation of cervical lymphadenopathy is a common diagnostic challenge facing clinicians. Previously at Kamuzu Central Hospital (KCH) tuberculosis (TB) was reported to be the most common cause of cervical lymphadenopathy However, no recent study has assessed this common diagnostic challenge in Malawi, particularly since the beginning of the HIV epidemic and the subsequent scale-up of antiretroviral therapy. Methods: We conducted a cross-sectional study of all cervical lymph node specimens from the KCH pathology laboratory between 1 July 2011 and 28 February 2013 and describe patient age, gender, and pathologic diagnoses. Results: Our search of the KCH pathology database yielded 179 cases. Of these, 143 (77%) were histologic specimens (open biopsy or core needle samples) while 34 (23%) were cytology specimens. The age range was from 0 to 76 years with a mean of 30 (SD: 19). In adults, the most common diagnosis was malignancy (n=41, 35%), while in children 15 cases each of malignancy and benign masses were diagnosed. Only 6 cases (5%) of TB were diagnosed in adults, and 4 cases (6%) of TB were diagnosed in children. Conclusion: Our study shows more malignancy and much less TB than a prior study of cervical lymphadenopathy at KCH. With the successful initiaion of the KCH Pathology Laboratory in 2011, we recommend biopsy or FNA early in the workup of cervical lymphadenopathy to prevent long delays in diagnosis and treatment of curable cancers

Early Experience after Developing a Pathology Laboratory in Malawi, with Emphasis on Cancer Diagnoses

Abstract Background: Despite increasing cancer burden in Malawi, pathology services are limited. We describe operations during the first 20 months of a new pathology laboratory in Lilongwe, with emphasis on cancer diagnoses

Early Experience after Developing a Pathology Laboratory in Malawi, with Emphasis on Cancer Diagnoses

BackgroundDespite increasing cancer burden in Malawi, pathology services are limited. We describe operations during the first 20 months of a new pathology laboratory in Lilongwe, with emphasis on cancer diagnoses.Methods and FindingsWe performed a cross-sectional study of specimens from the Kamuzu Central Hospital pathology laboratory between July 1, 2011 and February 28, 2013. Patient and specimen characteristics, and final diagnoses are summarized. Diagnoses were categorized as malignant, premalignant, infectious, other pathology, normal or benign, or nondiagnostic. Patient characteristics associated with premalignancy and malignancy were assessed using logistic regression. Of 2772 specimens, 2758 (99%) with a recorded final diagnosis were included, drawn from 2639 unique patients. Mean age was 38 years and 63% were female. Of those with documented HIV status, 51% had unknown status, and 36% with known status were infected. Histologic specimens comprised 91% of cases, and cytologic specimens 9%. Malignant diagnoses were most common overall (n = 861, 31%). Among cancers, cervical cancer was most common (n = 117, 14%), followed by lymphoma (n = 91, 11%), esophageal cancer (n = 86, 10%), sarcoma excluding Kaposi sarcoma (n = 75, 9%), and breast cancer (n = 61, 7%). HIV status was known for 95 (11%) of malignancies, with HIV prevalence ranging from 9% for breast cancer to 81% for cervical cancer. Increasing age was consistently associated with malignancy [bivariable odds ratio 1.24 per decade increase (95% CI 1.19–1.29) among 2685 patients with known age; multivariable odds ratio 1.33 per decade increase (95% CI 1.14–1.56) among 317 patients with known age, gender, and HIV status], while HIV infection and gender were not.ConclusionsDespite selection and referral bias inherent in these data, a new pathology laboratory in Lilongwe has created a robust platform for cancer care and research. Strategies to effectively capture clinical information for pathologically confirmed cancers can allow these data to complement population-based registration

Evaluating Nurses' Implementation of an Infant-Feeding Counseling Protocol for HIV-Infected Mothers: The Ban Study in Lilongwe, Malawi

A process evaluation of nurses’ implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study’s outcomes

Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmissio

Comparison between structural behavior of a steel and a composite wind tower

104 σ.Ο σκοπός της παρούσας διπλωματικής εργασίας είναι η μοντελοποίηση και διερεύνηση της συμπεριφοράς ενός πύργου από σύνθετα υλικά (Graphite/Epoxy) και ενός πύργου από χάλυβα S355 ύψους 50m, με τη χρήση του προγράμματος SOFiSTiK. Πραγματοποιήθηκε ιδιομορφική ανάλυση, έλεγχος αστοχίας του υλικού και ευστάθειας του κάθε φορέα υπό την επίδραση του δυσμενέστερου συνδυασμού φορτίσεων. Τα αποτελέσματα παρουσιάζονται αναλυτικά και γραφικά ενώ στο τέλος της εργασίας εξάγονται τα συμπεράσματα της έρευνας. Στο 1ο κεφάλαιο παρουσιάζονται γενικές πληροφορίες σχετικά με τις ανεμογεννήτριες, τα μέρη από τα οποία αποτελούνται και τους πύργους που τις στηρίζουν. Περιγράφεται η συμπεριφορά των σωληνωτών FRP κατασκευών καθώς και διάφορες προσπάθειες κατασκευής πύργου από σύνθετα υλικά. Στο 2ο κεφάλαιο περιγράφονται τα κύρια χαρακτηριστικά του ανέμου, που αποτελεί την κυρίαρχη φόρτιση στους πύργους ανεμογεννητριών. Στο 3ο κεφάλαιο περιγράφεται η γεωμετρία του φορέα και τα χαρακτηριστικά του. Παρουσιάζεται το υλικό που πρόκειται να χρησιμοποιηθεί για κάθε πύργο της ανεμογεννήτριας, οι ιδιότητές του και ο τρόπος κατασκευής του. Στο 4ο κεφάλαιο περιγράφονται και υπολογίζονται τα φορτία τα οποία ασκούνται απευθείας στον υπό εξέταση πύργο και εκείνα τα οποία μεταφέρονται από τη τουρμπίνα στην κορυφή του πύργου. Ακόμη περιγράφονται τα φορτία σεισμού και τα φορτία κόπωσης. Τέλος, δίνονται συγκεντρωτικά οι τιμές σχεδιασμού αυτών των φορτίων και οι συνδυασμοί των φορτίσεων. Στο 5ο κεφάλαιο περιγράφεται η διαδικασία της μοντελοποίησης με τη μέθοδο των πεπερασμένων στοιχείων και η εισαγωγή των δεδομένων στο πρόγραμμα SOFiSTiK. Παρατίθενται αναλυτικά τα βήματα που ακολουθήθηκαν για την εισαγωγή της γεωμετρίας του φορέα, τον καθορισμό του υλικού, την επιβολή των συνοριακών συνθηκών και την εφαρμογή των φορτίων. Στο 6ο κεφάλαιο παρουσιάζονται τα αποτελέσματα της στατικής και ιδιομορφικής ανάλυσης για κάθε φορέα για το δυσμενέστερο συνδυασμό φορτίσεων. Στο 7ο κεφάλαιο παρουσιάζονται τα συμπεράσματα της εργασίας καθώς και ιδέες για μελλοντική έρευνα.The main purpose of the present thesis is the modeling and study of the structural behavior of two wind towers 50m high (one made from steel S355 grade and one made from FRP materials – graphite/epoxy) with the aid of SOFiSTiK FE Analysis software. A static and dynamic analysis as well as material failure and stability check at limit state conditions is conducted. The results are presented both analytically and graphically and interesting conclusions are drawn. In Chapter 1, an introduction to the basic concepts of wind turbines, their consisting parts and wind towers is presented. The behavior of FRP tubular structures and an attempt to construct wind towers made from FRP composite materials is described. In Chapter 2, we analyze the main characteristics of the wind loading, which is the dominant load in wind turbine towers. In Chapter 3, the geometry of the structure and its characteristics are presented, as well as material properties and construction methods for each wind tower. In Chapter 4, the loads applied directly to the tower as well as those transferred from the turbine at the top of the tower are analyzed and calculated. Moreover, earthquake and fatigue loads are given. Finally, the aggregated values of the above design loads and combinations of loads are presented. In Chapter 5, the modeling process using the finite element method and the data entry procedure in the program SOFiSTiK is described i.e., the steps to enter geometry and material data for the structure as well as the boundary conditions and the applied loads. In Chapter 6, results from the static and dynamic analysis for the most unfavorable combination of loads are presented for each structure. In Chapter 7, interesting conclusions and ideas for future research are presented.Θεανώ Γ. Καμπάν